McPherson Medical & Diagnostic, LLC
Organization Active NPI Clinic/Center · Hayti, MO
NPI 1073154019 · NPPES record last updated Oct 1, 2019
Key facts
- NPI
- 1073154019
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- MCPHERSON MEDICAL & DIAGNOSTIC, LLC
- Practice address
- 223 S 3Rd St
Hayti, MO 63851-1617 - Phone
- (573) 717-1072
- NPI assigned
- Oct 1, 2019
- Organization subpart
- No
Authorized official
- Name
- Timothy William McPherson
- Title
- Ceo
- Phone
- (573) 695-2181
Other NPIs on the same Medicare enrollment 23
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 36
Practitioners 89
-
Abdullah Arshad, MD
-
Shawn K Brunk, DO
-
Connie Lynne Gurley, APRN-BC, FNP
-
Crystal Gail Jackson, FNP
-
Naser Almasalmeh, M.D.
-
Melinda Susan Auer, M.D.
-
Sarah Anne Brooks, FNP-C
-
Jordan Brotz, FNP
-
Lynda G Carlyle, FNP
-
Emmanuelson Chukwuyem, APRN
-
Laurell A Conder, NP-C
-
James L Deline, M.D.
-
Crystal Joy Dyer, FNP-C
-
Shellee Flora, FNP
-
Kayla Leann Fuller, MSN, APRN, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO, AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061201000167 | MO | Part B Supplier - Clinic/Group Practice | 5698773539 |
Receives reassigned benefits from 116 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kennett, MO; Macon, MO; Malden, MO; Saint Louis, MO; Saint Peters, MO; Scott City, MO; Steele, MO; Moberly, MO… |
| O20200723000803 | AR | Part B Supplier - Clinic/Group Practice | 5698773539 |
Receives reassigned benefits from 3 practitioners Practice locations: Blytheville, AR |
National Provider Directory
- Tax ID family
- McPherson Medical Diagnostic LLC
Locations
223 S 3rd St
Hayti, MO 63851
Phone (573) 359-2019
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
223 S 3Rd St
Hayti, MO 63851-1617
Mailing address
PO Box 12545
Belfast, ME 04915-4016
Phone (573) 717-1072
Other names
- Hayti Medical & Diagnostic
Other providers in Hayti, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.