Healthcare Provider Details

I. General information

NPI: 1164470191
Provider Name (Legal Business Name): MCDONOUGH COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E GRANT ST
MACOMB IL
61455-3313
US

IV. Provider business mailing address

525 E GRANT ST
MACOMB IL
61455-3313
US

V. Phone/Fax

Practice location:
  • Phone: 309-833-4101
  • Fax: 309-836-1525
Mailing address:
  • Phone: 309-833-4101
  • Fax: 309-836-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1001882
License Number StateIL

VIII. Authorized Official

Name: STEPHEN R HOPPER
Title or Position: PRESIDENT, CEO
Credential:
Phone: 309-833-4101