Basic Information
| Provider Information | |||||||||
| NPI: | 1821569005 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FERRELL HOSPITAL COMMUNITY FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 PINE ST | ||||||||
| Address2: | |||||||||
| City: | ELDORADO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629301634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182733361 | ||||||||
| FaxNumber: | 6182732504 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | MC LEANSBORO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628591139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186432835 | ||||||||
| FaxNumber: | 6182732504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 12/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | JODIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PATIENT FINANCIAL SERVICES DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6182733361 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FERRELL HOSPITAL COMMUNITY FOUNDATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.