Basic Information
| Provider Information | |||||||||
| NPI: | 1962970004 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MCFARLAND CLINIC, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 DUFF AVE | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152394401 | ||||||||
| FaxNumber: | 5152394791 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 DUFF AVE | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152394401 | ||||||||
| FaxNumber: | 5152394791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2018 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | JEB | ||||||||
| AuthorizedOfficialMiddleName: | ODEIN | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC. DIR. CLINICAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5152394452 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MCFARLAND CLINIC, PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.