Provider Demographics
NPI:1053446179
Name:RICHARD A MCGAHAN PSC
Entity Type:Organization
Organization Name:RICHARD A MCGAHAN PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-904-0845
Mailing Address - Street 1:7052 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7000
Mailing Address - Country:US
Mailing Address - Phone:270-904-0845
Mailing Address - Fax:270-904-2651
Practice Address - Street 1:1728 ROCKINGHAM AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3379
Practice Address - Country:US
Practice Address - Phone:270-904-0845
Practice Address - Fax:270-904-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY22000000059921OtherANTHEMBC/BS
KYCA6455OtherRR MEDICARE
KY50004948OtherPASSPORT HEALTH
KY65936353Medicaid
KYCA6455OtherRR MEDICARE