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General NPI Number Information
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NPI Number | 1124196795
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Entity Type | Organization
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Legal Business Name | MT HOPE FUNKS GROVE FIRE PROTECTION
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 209 SOUTH HAMILTON ST
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City | MCLEAN
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State | IL
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Zip | 61754
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Country | US
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Telephone | 309-874-2532
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Fax | 309-874-2096
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Provider Business Mailing Address
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Address Line | PO BOX 169
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City | MC LEAN
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State | IL
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Zip | 61754-0169
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Country | US
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Telephone | 309-874-2532
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Fax | 309-874-2096
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRENDA MCCALLISTER
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Credential |
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Telephone | 309-874-2532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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