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General NPI Number Information
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NPI Number | 1851968309
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Entity Type | Organization
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Legal Business Name | MCCLOUD MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 915 EAST FRK
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City | DINGESS
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State | WV
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Zip | 25671-6536
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Country | US
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Telephone | 304-784-2981
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Fax |
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Provider Business Mailing Address
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Address Line | 915 EAST FRK
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City | DINGESS
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State | WV
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Zip | 25671-6536
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Country | US
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Telephone | 304-784-2981
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Fax |
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Authorized Official
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Title or Position | APRN/EMPLOYEE
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Name | LISA SUE MCCLOUD
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Credential | APRN
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Telephone | 304-784-2981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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