Provider Demographics
NPI:1356446652
Name:REGIONAL FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:REGIONAL FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-932-3101
Mailing Address - Street 1:125 W SOUTH ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-3715
Mailing Address - Country:US
Mailing Address - Phone:309-853-3677
Mailing Address - Fax:309-853-3692
Practice Address - Street 1:125 W SOUTH ST
Practice Address - Street 2:SUITE 12
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-3715
Practice Address - Country:US
Practice Address - Phone:309-853-3677
Practice Address - Fax:309-853-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL208668Medicare PIN
IL=========003Medicaid