Provider Demographics
NPI:1376740910
Name:RURAL HEALTH CLINIC GREENUP
Entity Type:Organization
Organization Name:RURAL HEALTH CLINIC GREENUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-923-3311
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:IL
Mailing Address - Zip Code:62428-0817
Mailing Address - Country:US
Mailing Address - Phone:217-923-3311
Mailing Address - Fax:
Practice Address - Street 1:302 N MILL
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:IL
Practice Address - Zip Code:62428-0817
Practice Address - Country:US
Practice Address - Phone:217-923-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid