Active NPI
Mt Hope Funks Grove Fire Protection
- Land Ambulance
- McLean, IL
National Provider Identifier
1124196795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- MT HOPE FUNKS GROVE FIRE PROTECTION
- Practice address
- 209 South Hamilton St
McLean, IL 61754 - Phone
- (309) 874-2532
- Fax
- (309) 874-2096
- NPI assigned
- Dec 1, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brenda McCallister
- Title
- Director
- Phone
- (309) 874-2532
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Primary |
Addresses
Primary practice location
209 South Hamilton St
McLean, IL 61754
Mailing address
PO Box 169
MC Lean, IL 61754-0169
Phone (309) 874-2532
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120409000599 | IL | Part B Supplier - Ambulance Service Supplier | 9739340399 | Practice locations: MC Lean, IL |
National Provider Directory
National Provider DirectoryLocations
209 S Hamilton St
Mc Lean, IL 61754
Phone (309) 874-2532
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1333929600000",
"number": "1124196795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 169",
"city": "MC LEAN",
"state": "IL",
"postal_code": "617540169",
"telephone_number": "309-874-2532",
"fax_number": "309-874-2096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 SOUTH HAMILTON ST",
"city": "MCLEAN",
"state": "IL",
"postal_code": "61754",
"telephone_number": "309-874-2532",
"fax_number": "309-874-2096"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MT HOPE FUNKS GROVE FIRE PROTECTION",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-01",
"last_updated": "2012-04-09",
"status": "A",
"authorized_official_last_name": "MCCALLISTER",
"authorized_official_first_name": "BRENDA",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "309-874-2532"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.