Healthcare Provider Details

I. General information

NPI: 1962689240
Provider Name (Legal Business Name): CRAIG W. FURRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 N ATCHISON AVE SUITE C
MARION IL
62959-5426
US

IV. Provider business mailing address

1306 N ATCHISON AVE SUITE C
MARION IL
62959-5426
US

V. Phone/Fax

Practice location:
  • Phone: 618-998-1900
  • Fax: 618-998-1990
Mailing address:
  • Phone: 618-998-1900
  • Fax: 618-998-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLI S BOSS
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 618-998-1900