=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962970004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCFARLAND CLINIC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2018
-----------------------------------------------------
Last Update Date | 11/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 DUFF AVE
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-5745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-239-4401
-----------------------------------------------------
Fax | 515-239-4791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1215 DUFF AVE
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-5469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-239-4401
-----------------------------------------------------
Fax | 515-239-4791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC. DIR. CLINICAL OPERATIONS
-----------------------------------------------------
Name | JEB ODEIN LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-239-4452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------