MEDICARE: MCLD CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	252	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2028167	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609865369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLD CORPORATION

Provider Business Mailing Address
First Line	:	209 2ND ST SE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52401-1405
Country	:	US
Telephone Number	:	319-221-1050
Fax Number	:	319-221-1033

Provider Business Practice Location Address
First Line	:	810 12TH ST
Second Line	:
City	:	BELLE PLAINE
State	:	IA
Zip	:	52208-1709
Country	:	US
Telephone Number	:	319-444-2480
Fax Number	:	319-444-3987

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER TUETKEN
Credential	:	PHARM D
Telephone Number	:	319-221-1050

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	08/05/2014

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