=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700569670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCPHERSON MEDICAL & DIAGNOSTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2023
-----------------------------------------------------
Last Update Date | 08/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 HAZEL AVE
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64836-2850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-358-4685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 HAZEL AVE
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64836-2850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-358-4685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | ABDULLAH ARSHAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-724-0083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------