Healthcare Provider Details

I. General information

NPI: 1760625669
Provider Name (Legal Business Name): FERRELL HOSPITAL COMMUNITY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 LOCUST ST
ELDORADO IL
62930-1629
US

IV. Provider business mailing address

1407 LOCUST ST
ELDORADO IL
62930-1629
US

V. Phone/Fax

Practice location:
  • Phone: 618-273-3361
  • Fax: 618-273-5501
Mailing address:
  • Phone: 618-273-3361
  • Fax: 618-273-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: H WILLIAM HARTLEY
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 618-473-3361