Provider Demographics
NPI:1679706956
Name:MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Other - Org Name:MCPHERSON MEDICAL AND DIAGNOSTIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
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:573-717-1072
Mailing Address - Fax:573-717-1529
Practice Address - Street 1:901 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-1100
Practice Address - Country:US
Practice Address - Phone:573-717-1072
Practice Address - Fax:573-717-1529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-02
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10540Medicare UPIN