1427210517 NPI number — MS. MARY DARDEN MCLEOD NPC

Table of content: MS. MARY DARDEN MCLEOD NPC (NPI 1427210517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427210517 NPI number — MS. MARY DARDEN MCLEOD NPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLEOD
Provider First Name:
MARY
Provider Middle Name:
DARDEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINEBERGER
Provider Other First Name:
MARY DARDEN
Provider Other Middle Name:
MCLEOD
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427210517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1890
Provider Second Line Business Mailing Address:
321 MULBERRY STREET
Provider Business Mailing Address City Name:
LENOIR
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28645-1890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-757-5508
Provider Business Mailing Address Fax Number:
828-757-6141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 MULBERRY ST SW
Provider Second Line Business Practice Location Address:
EMPLOYEE FIRST CLINIC
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-757-5508
Provider Business Practice Location Address Fax Number:
828-757-6141
Provider Enumeration Date:
06/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  193347 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)