Provider Demographics
NPI:1619987898
Name:ESA SC
Entity Type:Organization
Organization Name:ESA SC
Other - Org Name:EFFINGHAM SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLYE JO
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-347-2565
Mailing Address - Street 1:900 W TEMPLE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2186
Mailing Address - Country:US
Mailing Address - Phone:217-347-2500
Mailing Address - Fax:217-342-9775
Practice Address - Street 1:900 W TEMPLE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2186
Practice Address - Country:US
Practice Address - Phone:217-347-2500
Practice Address - Fax:217-342-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042006074208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202604Medicare ID - Type UnspecifiedGROUP IDENTIFIER