MEDICARE: MARSHALL ASHBY C.R.N.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209003331	IL

General Provider Information

NPI Number	:	1154437671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL ASHBY C.R.N.A.

Provider Business Mailing Address
First Line	:	PO BOX 372
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-0372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HEALTH CENTER DR
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-9253
Country	:	US
Telephone Number	:	217-258-2440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/25/2024

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