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General NPI Number Information
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NPI Number | 1649677063
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Entity Type | Organization
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Legal Business Name | EFFINGHAM OBSTETRICS AND GYNECOLOGY ASSOCIATES PLLC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 912 N HENRIETTA ST
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City | EFFINGHAM
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State | IL
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Zip | 62401
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Country | US
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Telephone | 217-342-3337
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Fax | 217-347-3328
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Provider Business Mailing Address
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Address Line | PO BOX 784
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City | EFFINGHAM
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State | IL
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Zip | 62401-0784
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Country | US
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Telephone | 217-342-3337
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Fax | 217-347-3328
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Authorized Official
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Title or Position | MEMBER
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Name | KELLY HUNT HALLER
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Credential | M.D.
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Telephone | 217-342-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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