Healthcare Provider Details

I. General information

NPI: 1689217820
Provider Name (Legal Business Name): FERRELL HOSPITAL COMMUNITY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 05/22/2025
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S WASHINGTON STREET
MC LEANSBORO IL
62859-1139
US

IV. Provider business mailing address

1201 PINE ST
ELDORADO IL
62930-1634
US

V. Phone/Fax

Practice location:
  • Phone: 618-643-2835
  • Fax: 618-643-2891
Mailing address:
  • Phone: 618-273-3361
  • Fax: 618-273-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICKIE LINDSTROM
Title or Position: CLINIC PRACTICE MANAGER
Credential: RN BSN
Phone: 618-643-2855