Healthcare Provider Details

I. General information

NPI: 1649677063
Provider Name (Legal Business Name): EFFINGHAM OBSTETRICS AND GYNECOLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 N HENRIETTA ST
EFFINGHAM IL
62401
US

IV. Provider business mailing address

PO BOX 784
EFFINGHAM IL
62401-0784
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-3337
  • Fax: 217-347-3328
Mailing address:
  • Phone: 217-342-3337
  • Fax: 217-347-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY HUNT HALLER
Title or Position: MEMBER
Credential: M.D.
Phone: 217-342-3337