Provider Demographics
NPI:1952304412
Name:MARSHALL CLINIC EFFINGHAM, S.C.
Entity Type:Organization
Organization Name:MARSHALL CLINIC EFFINGHAM, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-342-4151
Mailing Address - Street 1:300 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2003
Mailing Address - Country:US
Mailing Address - Phone:217-342-4151
Mailing Address - Fax:217-342-4190
Practice Address - Street 1:300 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2003
Practice Address - Country:US
Practice Address - Phone:217-342-4151
Practice Address - Fax:217-342-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099940207N00000X
IL036085448207Q00000X
IL036084841207Q00000X
IL036112996207Q00000X
IL036108589207R00000X
IL036089116207R00000X, 208000000X
IL036094764207R00000X, 208000000X
IL036103305207R00000X, 208000000X
IL036095601208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCK1050OtherRAILROAD MEDICARE
IL14D0902430OtherCLIA
IL2523659OtherBC/BS GROUP PROVIDER #
IL0881270001OtherDME MAC, MEDICARE
IL2523659OtherBC/BS GROUP PROVIDER #
IL347560Medicare PIN