Provider Demographics
NPI:1184339939
Name:BDMACK, INC
Entity type:Organization
Organization Name:BDMACK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:LITHGOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-781-3162
Mailing Address - Street 1:406 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-1413
Mailing Address - Country:US
Mailing Address - Phone:217-781-3162
Mailing Address - Fax:217-391-4300
Practice Address - Street 1:1500 N 5TH ST STE 203
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2643
Practice Address - Country:US
Practice Address - Phone:217-284-9070
Practice Address - Fax:217-391-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based