Healthcare Provider Details

I. General information

NPI: 1316965197
Provider Name (Legal Business Name): HOOPESTON EMERGENCY MEDICINE SPECIALISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E ORANGE ST
HOOPESTON IL
60942-1801
US

IV. Provider business mailing address

6948 WINDSOR AVE
BERWYN IL
60402-3335
US

V. Phone/Fax

Practice location:
  • Phone: 708-393-7533
  • Fax:
Mailing address:
  • Phone: 708-393-7533
  • Fax: 708-394-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number042618113
License Number StateIL

VIII. Authorized Official

Name: DR. JOHN A. TIMMONS
Title or Position: PRESIDENT
Credential: MD
Phone: 708-393-7533