1215268586 NPI number — DONALD MCPHERSON NP

Table of content: DONALD MCPHERSON NP (NPI 1215268586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215268586 NPI number — DONALD MCPHERSON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCPHERSON
Provider First Name:
DONALD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215268586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1988
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41702-1988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-435-7642
Provider Business Mailing Address Fax Number:
606-436-5282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 CITIZENS LANE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41702-1988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-1300
Provider Business Practice Location Address Fax Number:
606-439-1400
Provider Enumeration Date:
01/26/2010

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:  6344P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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