Healthcare Provider Details

I. General information

NPI: 1306941695
Provider Name (Legal Business Name): REGIONAL FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S GALENA AVE
WYOMING IL
61491-1470
US

IV. Provider business mailing address

101 S GALENA AVE
WYOMING IL
61491-1470
US

V. Phone/Fax

Practice location:
  • Phone: 309-695-6448
  • Fax: 309-695-6447
Mailing address:
  • Phone: 309-695-6448
  • Fax: 309-695-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN JEFFRIES
Title or Position: CEO
Credential: M.D.
Phone: 309-932-3101