| Ryan Thomas Maccracken, | |
|
108 Larch Rd, Frankfort, IL 60423-1513 | |
| (815) 823-4108 | |
| Not Available |
| Full Name | Ryan Thomas Maccracken |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 108 Larch Rd, Frankfort, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609546324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 209027569 (Illinois) | Primary |
| 163W00000X | Registered Nurse | 041462258 (Illinois) | Secondary |
| Entity Name | Novus Illinois Service Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1295491744 PECOS PAC ID: 6901293786 Enrollment ID: O20220426000454 |
| Mailing Address | Practice Location Address |
|---|---|
| Ryan Thomas Maccracken, 108 Larch Rd, Frankfort, IL 60423-1513 Ph: (815) 823-4108 | Ryan Thomas Maccracken, 108 Larch Rd, Frankfort, IL 60423-1513 Ph: (815) 823-4108 |
Tiffany Richardson, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 21120 Washington Pkwy, Frankfort, IL 60423 Phone: 815-469-9750 | |
Bertrand D Chauff, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 21120 Washington Pkwy, Frankfort, IL 60423 Phone: 815-469-9750 Fax: 815-469-9752 | |
Robert Wilkins, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 481 Pleasant Hill Rd, Frankfort, IL 60423 Phone: 217-417-2849 |