Healthcare Provider Details

I. General information

NPI: 1548526932
Provider Name (Legal Business Name): MISSION CARE OF ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 INDUSTRIAL PARK RD
BENTON IL
62812-4541
US

IV. Provider business mailing address

PO BOX 847199
DALLAS TX
75284-7199
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-1212
  • Fax:
Mailing address:
  • Phone: 800-913-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SCOTT TIERNEY
Title or Position: EVP, CHIEF FINANCIAL OFFICER
Credential:
Phone: 833-703-2294