# MITCHELL-JERDAN FUNERAL HOME LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mitchell-Jerdan Ambulance Service
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245453190
- **Authorized official:** MR. GREGORY L. JERDAN (PRESIDENT)
- **Authorized official phone:** (217) 234-8828

## Contact information

- **Practice address:** 1200 WABASH AVE, MATTOON, IL 61938-4142
- **Practice address phone:** (217) 234-8828
- **Practice address fax:** (217) 258-0786
- **Mailing address:** 1200 WABASH AVE, MATTOON, IL 61938-4142
- **Mailing address phone:** (217) 234-8828
- **Mailing address fax:** (217) 258-0786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 66792 | IL | Yes |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 03/13/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0001570051 | BLUE CROSS BLUE SHIELD | IL |
| 01 | — | 168847 | PERSONAL CARE INSURANCE | IL |
| 01 | — | 590128024 | RAILROAD MEDICARE | IL |