Healthcare Provider Details

I. General information

NPI: 1952304412
Provider Name (Legal Business Name): MARSHALL CLINIC EFFINGHAM, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MAPLE ST
EFFINGHAM IL
62401-2003
US

IV. Provider business mailing address

300 N MAPLE ST
EFFINGHAM IL
62401-2003
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-4151
  • Fax: 217-342-4190
Mailing address:
  • Phone: 217-342-4151
  • Fax: 217-342-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036099940
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036085448
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036084841
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036112996
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036108589
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036089116
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036094764
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036103305
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036089116
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036103305
License Number StateIL
# 11
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036094764
License Number StateIL
# 12
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036095601
License Number StateIL

VIII. Authorized Official

Name: DR. HOPE E KNAUER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 217-342-4151