Healthcare Provider Details

I. General information

NPI: 1184552093
Provider Name (Legal Business Name): ADVANCE CARE MEDICAL MANAGEMENT ACMM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 W CHURCH ST # A1
SANDWICH IL
60548-2082
US

IV. Provider business mailing address

347 W CHURCH ST # A1
SANDWICH IL
60548-2082
US

V. Phone/Fax

Practice location:
  • Phone: 815-414-4626
  • Fax:
Mailing address:
  • Phone: 815-414-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DEREK A. HAGERTY
Title or Position: OWNER
Credential: FF/PM
Phone: 815-414-4626