Basic Information
| Provider Information | |||||||||
| NPI: | 1073835013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTER REACH FAMILY MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98 PEACH RIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | ANNA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186141400 | ||||||||
| FaxNumber: | 6186141401 | ||||||||
| Practice Location | |||||||||
| Address1: | 98 PEACH RIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | ANNA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186141400 | ||||||||
| FaxNumber: | 6186141401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2010 | ||||||||
| LastUpdateDate: | 11/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER-REACH | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6186141400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036099509 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.