Healthcare Provider Details

I. General information

NPI: 1871990929
Provider Name (Legal Business Name): MCCONAGHY HOME MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16900 JORDAN STREET SUITE B
CHATOM AL
36518
US

IV. Provider business mailing address

P. O. BOX 1325
CHATOM AL
36518
US

V. Phone/Fax

Practice location:
  • Phone: 251-769-2082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateAL

VIII. Authorized Official

Name: DAN MCCONAGHY
Title or Position: OWNER
Credential: RPH
Phone: 251-769-2082