Healthcare Provider Details

I. General information

NPI: 1770100414
Provider Name (Legal Business Name): MCDONOUGH COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E GRANT ST STE 202
MACOMB IL
61455-3373
US

IV. Provider business mailing address

PO BOX 1179
MACOMB IL
61455-5579
US

V. Phone/Fax

Practice location:
  • Phone: 309-833-1729
  • Fax: 309-836-1779
Mailing address:
  • Phone: 309-836-1524
  • Fax: 309-836-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MURDOCK
Title or Position: CFO
Credential:
Phone: 563-244-3511