Provider Demographics
NPI:1164440806
Name:MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-695-2181
Mailing Address - Street 1:PO BOX 12545
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4016
Mailing Address - Country:US
Mailing Address - Phone:573-448-3800
Mailing Address - Fax:573-448-8909
Practice Address - Street 1:216 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STEELE
Practice Address - State:MO
Practice Address - Zip Code:63877-1436
Practice Address - Country:US
Practice Address - Phone:573-695-2181
Practice Address - Fax:573-695-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9E31207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty