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General NPI Number Information
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NPI Number | 1124679774
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Entity Type | Organization
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Legal Business Name | MCPHERSON MEDICAL & DIAGNOSTIC, LLC
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 304 TEACO RD STE A
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City | KENNETT
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State | MO
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Zip | 63857-3268
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Country | US
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Telephone | 573-717-1072
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12545
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City | BELFAST
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State | ME
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Zip | 04915-4016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | AMELIA DORIS LEDBETTER
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Credential |
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Telephone | 573-335-4715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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