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General NPI Number Information
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NPI Number | 1184552093
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Entity Type | Organization
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Legal Business Name | ADVANCE CARE MEDICAL MANAGEMENT ACMM
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 347 W CHURCH ST # A1
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City | SANDWICH
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State | IL
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Zip | 60548-2082
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Country | US
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Telephone | 815-414-4626
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Fax |
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Provider Business Mailing Address
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Address Line | 347 W CHURCH ST # A1
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City | SANDWICH
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State | IL
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Zip | 60548-2082
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Country | US
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Telephone | 815-414-4626
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEREK A. HAGERTY
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Credential | FF/PM
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Telephone | 815-414-4626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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