Healthcare Provider Details

I. General information

NPI: 1255369427
Provider Name (Legal Business Name): FRANKLIN HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BAILEY LANE
BENTON IL
62812-0000
US

IV. Provider business mailing address

201 BAILEY LANE
BENTON IL
62812-0000
US

V. Phone/Fax

Practice location:
  • Phone: 618-439-3161
  • Fax: 618-439-4049
Mailing address:
  • Phone: 618-439-3161
  • Fax: 618-439-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036085111
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002236
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209005496
License Number StateIL

VIII. Authorized Official

Name: RIKKI BONTHRON
Title or Position: CFO
Credential:
Phone: 618-439-3161