Healthcare Provider Details

I. General information

NPI: 1205230844
Provider Name (Legal Business Name): HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E SOUTHLINE RD
TUSCOLA IL
61953-2014
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-253-5231
  • Fax: 217-253-4082
Mailing address:
  • Phone: 217-383-3311
  • Fax: 217-367-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. HARRY BROCKUS
Title or Position: CEO
Credential:
Phone: 217-283-8540