Provider Demographics
NPI:1417147711
Name:MCDONAGH MEDICAL CENTER,INC.
Entity Type:Organization
Organization Name:MCDONAGH MEDICAL CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:816-453-5940
Mailing Address - Street 1:2800 NE KENDALLWOOD PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2026
Mailing Address - Country:US
Mailing Address - Phone:816-453-5940
Mailing Address - Fax:
Practice Address - Street 1:2800 NE KENDALLWOOD PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-2026
Practice Address - Country:US
Practice Address - Phone:816-453-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty