Mitchell-Jerdan Funeral Home LTD

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

66792 Issued in IL

Legal business name

MITCHELL-JERDAN FUNERAL HOME LTD

Practice address

1200 Wabash Ave
Mattoon, IL 61938-4142

Phone

(217) 234-8828

Fax

(217) 258-0786

NPI assigned

Apr 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gregory L. Jerdan

Title

President

Phone

(217) 234-8828

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Mitchell-Jerdan Ambulance Service Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331596800000",
    "number": "1245453190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 WABASH AVE",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384142",
            "telephone_number": "217-234-8828",
            "fax_number": "217-258-0786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 WABASH AVE",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384142",
            "telephone_number": "217-234-8828",
            "fax_number": "217-258-0786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL-JERDAN FUNERAL HOME LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2012-03-13",
        "status": "A",
        "authorized_official_last_name": "JERDAN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-234-8828",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "66792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CARE INSURANCE",
            "identifier": "168847",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590128024",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0001570051",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mitchell-Jerdan Ambulance Service",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kara Millis, RDN, LDN
• Megan Mills, RSA
• Zachary Mills, RSA
• Venkat R Minnaganti, M.D.
• Thomas L Minogue, MD
• Shania Mitchell
• Ragai Mitry, M.D.
• Esaie Momgbet
• Tiffany Ellen Monroe
• Earline Cynthel Montgomery

• Land Ambulance in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.

Verify at the official NPI Registry.