Basic Information
Provider Information | |||||||||
NPI: | 1437370400 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
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Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | PO BOX 155 | ||||||||
Address2: |   | ||||||||
City: | CHRISTOPHER | ||||||||
State: | IL | ||||||||
PostalCode: | 628220155 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6187242401 | ||||||||
FaxNumber: | 6187242571 | ||||||||
Practice Location | |||||||||
Address1: | 4241 STATE HWY 14 W | ||||||||
Address2: | CHRISTOPHER RURAL HEALTH PLANNING CORPORATION | ||||||||
City: | CHRISTOPHER | ||||||||
State: | IL | ||||||||
PostalCode: | 62822 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6187242401 | ||||||||
FaxNumber: | 6187244628 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2007 | ||||||||
LastUpdateDate: | 01/25/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
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ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MITROKA | ||||||||
AuthorizedOfficialFirstName: | KIM | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
AuthorizedOfficialTelephone: | 6187242401 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
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NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 101Y00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |   | 133V00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |   | 207R00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208000000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |   | 363A00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 261QF0400X |   | IL | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.