Provider Demographics
NPI:1962689240
Name:CRAIG W. FURRY
Entity Type:Organization
Organization Name:CRAIG W. FURRY
Other - Org Name:SOUTHERN ILLINOIS IMMEDIATE CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-998-1900
Mailing Address - Street 1:1306 N ATCHISON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5426
Mailing Address - Country:US
Mailing Address - Phone:618-998-1900
Mailing Address - Fax:618-998-1990
Practice Address - Street 1:1306 N ATCHISON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5426
Practice Address - Country:US
Practice Address - Phone:618-998-1900
Practice Address - Fax:618-998-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
783820Medicare Oscar/Certification