Healthcare Provider Details

I. General information

NPI: 1619987898
Provider Name (Legal Business Name): ESA SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W TEMPLE AVE SUITE 101
EFFINGHAM IL
62401-2186
US

IV. Provider business mailing address

900 W TEMPLE AVE SUITE 101
EFFINGHAM IL
62401-2186
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-2500
  • Fax: 217-342-9775
Mailing address:
  • Phone: 217-347-2500
  • Fax: 217-342-9775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number042006074
License Number StateIL

VIII. Authorized Official

Name: MS. BILLYE JO RITCHEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 217-347-2565