- Enrollment id
- O20100729000608
- Enrollment state
- IL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1467410282
- Multiple npi flag
- N
- Ccn
- 141524
- Associate id
- 0446140180
- Organization name
- MCDONOUGH COUNTY HOSPITAL DISTRICT
- Doing business as name
- MCDONOUGH DISTRICT HOSPITAL
- Incorporation date
- 1955-03-16
- Incorporation state
- IL
- Organization type structure
- OTHER
- Organization other type text
- HOSPITAL DISTRICT
- Proprietary nonprofit
- N
- Address line 1
- 525 E GRANT ST
- City
- MACOMB
- State
- IL
- Zip code
- 614553313