Organization
MITCHELL-JERDAN FUNERAL HOME LTD
Active
Other names
Mitchell-Jerdan Ambulance Service
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY L. JERDAN (PRESIDENT)
(217) 234-8828
Entity
Organization
Contact information
Practice address
1200 WABASH AVE, MATTOON, IL 61938-4142
(217) 234-8828
(217) 258-0786
Mailing address
1200 WABASH AVE, MATTOON, IL 61938-4142
(217) 234-8828
(217) 258-0786
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
66792
IL
Other
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
Enumeration date
04/10/2007
Last updated
03/13/2012
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