Provider Demographics
NPI:1700011046
Name:FERRELL HOSPITAL COMMUNITY FOUNDATION
Entity Type:Organization
Organization Name:FERRELL HOSPITAL COMMUNITY FOUNDATION
Other - Org Name:ELDORADO FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-273-3361
Mailing Address - Street 1:1300 US HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-3765
Mailing Address - Country:US
Mailing Address - Phone:618-297-9660
Mailing Address - Fax:618-273-2110
Practice Address - Street 1:1300 US HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-3765
Practice Address - Country:US
Practice Address - Phone:618-297-9660
Practice Address - Fax:618-273-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213703Medicare PIN
IL148507Medicare PIN