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Organization

JACKSONVILLE CRNAS INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID A BOLEN (VICE PRESIDENT & CFO)
(217) 245-9541
Entity
Organization

Contact information

Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-9541
(217) 479-8781
Mailing address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-9541
(217) 479-8781

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Enumeration date
07/29/2010
Last updated
07/31/2013
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