Provider Demographics
NPI:1023100153
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 1:336 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GALVA
Mailing Address - State:IL
Mailing Address - Zip Code:61434-1365
Mailing Address - Country:US
Mailing Address - Phone:309-932-3101
Mailing Address - Fax:309-932-3154
Practice Address - Street 1:336 FRONT ST
Practice Address - Street 2:
Practice Address - City:GALVA
Practice Address - State:IL
Practice Address - Zip Code:61434-1365
Practice Address - Country:US
Practice Address - Phone:309-932-3101
Practice Address - Fax:309-932-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
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=========001Medicaid
IL=========001Medicaid
IL208668Medicare PIN