| NPI | 1790705507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY KRUSE CEO 217-545-7876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 208600000X Surgery | |
| 2086S0120X Surgery, Pediatric Surgery | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery | |
| 208800000X Urology | |
| 2088P0231X Urology, Pediatric Urology | |
| 208C00000X Colon & Rectal Surgery | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2022-07-21 |