Healthcare Provider Details

I. General information

NPI: 1275616740
Provider Name (Legal Business Name): HOPEDALE MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 TREMONT ST.
HOPEDALE IL
61747-0267
US

IV. Provider business mailing address

107 TREMONT
HOPEDALE IL
61747-0267
US

V. Phone/Fax

Practice location:
  • Phone: 309-449-3321
  • Fax:
Mailing address:
  • Phone: 309-449-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK F. ROSSI
Title or Position: C.O.O.
Credential:
Phone: 309-449-4394