Organization
EDWARD F MCKENNEY D O S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD F MCKENNEY DO (PRESIDENT)
(217) 847-3383
Entity
Organization
Contact information
Practice address
1471 KEOKUK ST, HAMILTON, IL 62341-1135
(217) 847-3383
(217) 847-2832
Mailing address
1471 KEOKUK ST, HAMILTON, IL 62341-1135
(217) 847-3383
(217) 847-2832
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036058009
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058009
—
IL
01
—
IL4126
GROUP PTAN
IL
01
—
IL4126001
INDIVIDUAL PTAN
IL
Enumeration date
11/30/2010
Last updated
02/25/2011
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