Provider Demographics
NPI:1598792376
Name:PEARSALL, CLARENCE L (CRNA)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:L
Last Name:PEARSALL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1977
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62705-1977
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:217-757-6021
Practice Address - Street 1:1000 N ALLEN ST
Practice Address - Street 2:CRAWFORD MEMORIAL HOSPITAL
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1167
Practice Address - Country:US
Practice Address - Phone:618-546-2410
Practice Address - Fax:618-546-2613
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00042144OtherRR MEDICARE PIN
IL01732004OtherBLUE CROSS/BLUE SHIELD
ILDA2630OtherRR MEDICARE GRP#
IL542903OtherHEALTHLINK
IL542903OtherHEALTHLINK
ILL99482Medicare PIN