Healthcare Provider Details

I. General information

NPI: 1073917266
Provider Name (Legal Business Name): MCCONAGHY HOME MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179A S JACKSON ST
GROVE HILL AL
36451-3009
US

IV. Provider business mailing address

PO BOX 789 179-A SOUTH JACKSON STREET
SATSUMA AL
36572-0789
US

V. Phone/Fax

Practice location:
  • Phone: 251-275-3964
  • Fax: 251-275-4310
Mailing address:
  • Phone: 251-275-3964
  • Fax: 251-275-4310

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
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateAL

VIII. Authorized Official

Name: DAN MCCONAGHY
Title or Position: OWNER
Credential: RPH
Phone: 251-275-3964