Provider Demographics
NPI:1467486233
Name:CONNER & MCCONAGHY INC
Entity Type:Organization
Organization Name:CONNER & MCCONAGHY INC
Other - Org Name:C & M VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONAGHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-675-3228
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572-0558
Mailing Address - Country:US
Mailing Address - Phone:251-675-3228
Mailing Address - Fax:251-675-4209
Practice Address - Street 1:5567 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:SATSUMA
Practice Address - State:AL
Practice Address - Zip Code:36572-2108
Practice Address - Country:US
Practice Address - Phone:251-675-3228
Practice Address - Fax:251-675-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
AL1020303336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002511Medicaid
0136538OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0648650001Medicare NSC