Provider Demographics
NPI:1205025681
Name:FAMILY RURAL HEALTH OF LAHARPE, PC
Entity Type:Organization
Organization Name:FAMILY RURAL HEALTH OF LAHARPE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRIM
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:217-659-3844
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:LA HARPE
Mailing Address - State:IL
Mailing Address - Zip Code:61450-0468
Mailing Address - Country:US
Mailing Address - Phone:217-659-3844
Mailing Address - Fax:217-659-3850
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LA HARPE
Practice Address - State:IL
Practice Address - Zip Code:61450-9461
Practice Address - Country:US
Practice Address - Phone:217-659-3844
Practice Address - Fax:217-659-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060008196261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL143811Medicare Oscar/Certification