Provider Demographics
NPI:1326372715
Name:MCCONNEHEY HOLDINGS, INC
Entity Type:Organization
Organization Name:MCCONNEHEY HOLDINGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCONNEHEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-452-6794
Mailing Address - Street 1:888 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8638
Mailing Address - Country:US
Mailing Address - Phone:208-452-6794
Mailing Address - Fax:
Practice Address - Street 1:888 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8638
Practice Address - Country:US
Practice Address - Phone:208-452-6794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty