Provider Demographics
NPI:1427517887
Name:E & J MCDONNELL INC
Entity type:Organization
Organization Name:E & J MCDONNELL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:330-510-1890
Mailing Address - Street 1:8166 MARKET ST STE H
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6247
Mailing Address - Country:US
Mailing Address - Phone:330-510-1890
Mailing Address - Fax:330-510-1963
Practice Address - Street 1:8166 MARKET ST STE H
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6247
Practice Address - Country:US
Practice Address - Phone:330-510-1890
Practice Address - Fax:330-510-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201861Medicaid