Provider Demographics
NPI:1639159213
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
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO PRESIDENT
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:PO BOX 155
Mailing Address - Street 2:CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP
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 1:4241 HWY 14 WEST
Practice Address - Street 2:REA CLINIC
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822
Practice Address - Country:US
Practice Address - Phone:618-724-2401
Practice Address - Fax:618-724-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL=========003Medicaid
IL141819Medicare ID - Type Unspecified