Healthcare Provider Details

I. General information

NPI: 1356698310
Provider Name (Legal Business Name): MCDONOUGH COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E GRANT ST SUITE 202
MACOMB IL
61455-3352
US

IV. Provider business mailing address

505 E GRANT ST SUITE 202
MACOMB IL
61455-3352
US

V. Phone/Fax

Practice location:
  • Phone: 309-833-1729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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