Healthcare Provider Details

I. General information

NPI: 1609041128
Provider Name (Legal Business Name): MCLD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W MISSION ST
STRAWBERRY POINT IA
52076
US

IV. Provider business mailing address

207 2ND AVE SE STE A
CEDAR RAPIDS IA
52401-1238
US

V. Phone/Fax

Practice location:
  • Phone: 563-933-4762
  • Fax: 563-933-9909
Mailing address:
  • Phone: 319-221-1033
  • Fax: 319-221-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number68
License Number StateIA

VIII. Authorized Official

Name: CHRISTOPHER TUETKEN
Title or Position: PRES
Credential: PHARM D
Phone: 319-221-1050