Healthcare Provider Details

I. General information

NPI: 1881032985
Provider Name (Legal Business Name): MCDONOUGH COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E GRANT ST
MACOMB IL
61455-3368
US

IV. Provider business mailing address

515 E GRANT ST
MACOMB IL
61455-3368
US

V. Phone/Fax

Practice location:
  • Phone: 309-833-6937
  • Fax:
Mailing address:
  • Phone: 309-833-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0001438
License Number StateIL

VIII. Authorized Official

Name: KENNY BOYD JR.
Title or Position: CEO
Credential:
Phone: 309-833-4101