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NPI Code Detail

MEDICARE: MARY MCADOO

MEDICARE: MARY MCADOO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician4916SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265405062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY MCADOO
Provider Business Mailing Address
First Line : 194 PINE CONE AVE
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-8638
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : QUEEN CITY REGIONAL MEDICAL CLINIC
Second Line : 1420 N. 10TH STREET
City : SPEARFISH
State : SD
Zip : 57783-1532
Country : US
Telephone Number : 605-642-8414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 08/13/2007

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Directions to “ MARY MCADOO ” Practice Location

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