Provider Demographics
NPI:1164594594
Name:HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HOOPESTON COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:HOOPESTON COMMUNITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-283-5531
Mailing Address - Street 1:701 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:HOOPESTON
Mailing Address - State:IL
Mailing Address - Zip Code:60942-1801
Mailing Address - Country:US
Mailing Address - Phone:217-283-5531
Mailing Address - Fax:217-283-7981
Practice Address - Street 1:701 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:HOOPESTON
Practice Address - State:IL
Practice Address - Zip Code:60942-1801
Practice Address - Country:US
Practice Address - Phone:217-283-5531
Practice Address - Fax:217-283-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-005OtherBCBSIL AMBULANCE #
IL=========006Medicaid
IL=========-005OtherBCBSIL AMBULANCE #