| Mr Richard Earl Boren, CRNA | |
|
2 S Hospital Dr, Murphysboro, IL 62966-3333 | |
| (618) 684-3156 | |
| (618) 529-0529 |
| Full Name | Mr Richard Earl Boren |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 2 S Hospital Dr, Murphysboro, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346353117 | NPI | - | NPPES |
| 214881 | Other | IL | MEDICARE MULTISPECIALTY GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 209-005603 (Illinois) | Primary |
| Entity Name | Marion Anesthesia Company Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1790721579 PECOS PAC ID: 3577522010 Enrollment ID: O20041008000899 |
| Entity Name | Southern Illinois Medical Services Nfp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770656837 PECOS PAC ID: 3678677390 Enrollment ID: O20070404000595 |
| Entity Name | Northstar Anesthesia Of Illinois, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962822395 PECOS PAC ID: 4688893878 Enrollment ID: O20140922000405 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Richard Earl Boren, CRNA 2 S Hospital Dr, Murphysboro, IL 62966-3333 Ph: (618) 684-3156 | Mr Richard Earl Boren, CRNA 2 S Hospital Dr, Murphysboro, IL 62966-3333 Ph: (618) 684-3156 |
John D Lundeberg, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 2 S Hospital Dr, Murphysboro, IL 62966 Phone: 618-684-3156 Fax: 618-529-0529 | |
Louise Mary Vaughn, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 2 S Hospital Dr, Murphysboro, IL 62966 Phone: 618-684-3156 |