Provider Demographics
NPI:1548240211
Name:CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP
Entity Type:Organization
Organization Name:CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP
Other - Org Name:REA CLINIC BENTON
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITROKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-724-2436
Mailing Address - Street 1:CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP
Mailing Address - Street 2:PO BOX 155
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:REA CLINIC BENTON
Practice Address - Street 2:201 BAILEY LANE
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812
Practice Address - Country:US
Practice Address - Phone:618-438-3113
Practice Address - Fax:618-438-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141892Medicare ID - Type Unspecified
317270Medicare ID - Type Unspecified
IL=========004Medicare ID - Type Unspecified