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General NPI Number Information
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NPI Number | 1225330087
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Entity Type | Organization
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Legal Business Name | EDWARD F MCKENNEY D O S C
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 1471 KEOKUK ST
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City | HAMILTON
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State | IL
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Zip | 62341-1135
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Country | US
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Telephone | 217-847-3383
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Fax | 217-847-2832
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Provider Business Mailing Address
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Address Line | 1471 KEOKUK ST
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City | HAMILTON
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State | IL
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Zip | 62341-1135
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Country | US
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Telephone | 217-847-3383
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Fax | 217-847-2832
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD F MCKENNEY
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Credential | DO
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Telephone | 217-847-3383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036058009
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License Number State | IL
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