Healthcare Provider Details

I. General information

NPI: 1780192013
Provider Name (Legal Business Name): MCDONOUGH COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 E GRANT ST
MACOMB IL
61455-3311
US

IV. Provider business mailing address

515 E GRANT ST ATTN MMG FINANCIAL SERVICES
MACOMB IL
61455-3368
US

V. Phone/Fax

Practice location:
  • Phone: 309-837-3964
  • Fax:
Mailing address:
  • Phone: 309-836-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: LINDA KATHLEEN DACE
Title or Position: VP OF FINANCE
Credential:
Phone: 309-833-4101