Provider Demographics
NPI:1760447353
Name:MCGATH, RICKEY L (MD)
Entity type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:L
Last Name:MCGATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-0083
Mailing Address - Country:US
Mailing Address - Phone:870-857-3334
Mailing Address - Fax:870-857-9934
Practice Address - Street 1:1300 CREASON RD
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-1716
Practice Address - Country:US
Practice Address - Phone:870-857-3399
Practice Address - Fax:870-857-3301
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO104970006Medicare PIN
000010497Medicare PIN
A25227Medicare UPIN
MO000013896Medicare PIN
MO202171625Medicaid
MO000013896Medicare PIN