Provider Demographics
NPI:1700866381
Name:CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Entity Type:Organization
Organization Name:CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Other - Org Name:
Other - Org Type:
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:618-724-2401
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:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:3303 LOGAN DR
Practice Address - Street 2:REA CLINIC HERRIN
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3732
Practice Address - Country:US
Practice Address - Phone:618-993-5767
Practice Address - Fax:618-993-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========005Medicaid
IL141891Medicare ID - Type Unspecified
617270Medicare ID - Type Unspecified