Provider Demographics
NPI:1831361344
Name:RURAL HEALTH CLINIC OF MOULTRIE COUNTY LLC
Entity type:Organization
Organization Name:RURAL HEALTH CLINIC OF MOULTRIE COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-728-7353
Mailing Address - Street 1:2 W ADAMS
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1943
Mailing Address - Country:US
Mailing Address - Phone:217-728-7353
Mailing Address - Fax:217-728-2580
Practice Address - Street 1:2 W ADAMS
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-1943
Practice Address - Country:US
Practice Address - Phone:217-728-7353
Practice Address - Fax:217-728-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143847Medicare Oscar/Certification