Provider Demographics
NPI:1225223829
Name:CRAIG W. FURRY
Entity Type:Organization
Organization Name:CRAIG W. FURRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:FURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-542-2129
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-5080
Mailing Address - Country:US
Mailing Address - Phone:618-542-2129
Mailing Address - Fax:618-542-2903
Practice Address - Street 1:20 N WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1403
Practice Address - Country:US
Practice Address - Phone:618-542-2129
Practice Address - Fax:618-542-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067057261QP2300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148924Medicare Oscar/Certification