Provider Demographics
NPI:1255369427
Name:FRANKLIN HOSPITAL DISTRICT
Entity type:Organization
Organization Name:FRANKLIN HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BONTHRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-439-3161
Mailing Address - Street 1:201 BAILEY LANE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-0000
Mailing Address - Country:US
Mailing Address - Phone:618-439-3161
Mailing Address - Fax:618-439-4049
Practice Address - Street 1:201 BAILEY LANE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-0000
Practice Address - Country:US
Practice Address - Phone:618-439-3161
Practice Address - Fax:618-439-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005496363LF0000X
207R00000X
IL085002236363A00000X
IL036085111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209232Medicare ID - Type UnspecifiedILLINOIS MEDICARE