Provider Demographics
NPI:1619518032
Name:MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
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:573-717-1072
Mailing Address - Fax:
Practice Address - Street 1:110 US HWY 61 N
Practice Address - Street 2:STE B
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851
Practice Address - Country:US
Practice Address - Phone:573-717-1072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center