Provider Demographics
NPI:1821335134
Name:CHARLES E MCGRATH DO PC
Entity Type:Organization
Organization Name:CHARLES E MCGRATH DO PC
Other - Org Name:NOLAND FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:816-254-1781
Mailing Address - Street 1:514 S NOLAND RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-3976
Mailing Address - Country:US
Mailing Address - Phone:816-254-1781
Mailing Address - Fax:816-254-2182
Practice Address - Street 1:514 S NOLAND RD
Practice Address - Street 2:SUITE 130
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-3976
Practice Address - Country:US
Practice Address - Phone:816-254-1781
Practice Address - Fax:816-254-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34431261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0002621AMedicare UPIN