Basic Information
| Provider Information | |||||||||
| NPI: | 1730133505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 155 | ||||||||
| Address2: | CHRISTOPHER RURAL HEALTH PLANNING CORPORATION | ||||||||
| City: | CHRISTOPHER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6187242401 | ||||||||
| FaxNumber: | 6187244628 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 GAS PLANT ROAD | ||||||||
| Address2: | REA CLINIC DUQUOIN | ||||||||
| City: | DUQUOIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185428702 | ||||||||
| FaxNumber: | 6185428792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 10/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036115579 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | 036115579 | IL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.