=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144041526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCPHERSON MEDICAL & DIAGNOSTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2024
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 TEACO RD
-----------------------------------------------------
City | KENNETT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63857-3236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-888-0001
-----------------------------------------------------
Fax | 573-888-0006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 308
-----------------------------------------------------
City | KENNETT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63857-0308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-888-0001
-----------------------------------------------------
Fax | 573-888-0006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ABDULLAH ARSHAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-724-0083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------