MEDICARE: CRAIG W. FURRY

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	261QP2300X	Primary Care Clinic/Center	036067057	IL
2	261QR1300X	Rural Health Clinic/Center	036067057	IL

General Provider Information

NPI Number	:	1225223829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG W. FURRY

Provider Business Mailing Address
First Line	:	PO BOX 1080
Second Line	:	SUITE 2
City	:	DU QUOIN
State	:	IL
Zip	:	62832-5080
Country	:	US
Telephone Number	:	618-542-2129
Fax Number	:	618-542-2903

Provider Business Practice Location Address
First Line	:	20 N WASHINGTON ST
Second Line	:	SUITE 2
City	:	DU QUOIN
State	:	IL
Zip	:	62832-1403
Country	:	US
Telephone Number	:	618-542-2129
Fax Number	:	618-542-2903

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CRAIG W FURRY
Credential	:	MD
Telephone Number	:	618-542-2129

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	10/29/2009

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Directions to “CRAIG W. FURRY ” Practice Location

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