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General NPI Number Information
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NPI Number | 1366639759
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Entity Type | Organization
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Legal Business Name | RURAL FAMILY MEDICINE ASSOCIATES, LTD
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 739 N JEFFERSON ST SUITE 200
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City | MASCOUTAH
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State | IL
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Zip | 62258-1447
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Country | US
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Telephone | 618-566-8810
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Fax | 618-566-7121
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Provider Business Mailing Address
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Address Line | 739 N JEFFERSON ST SUITE 200
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City | MASCOUTAH
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State | IL
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Zip | 62258-1447
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Country | US
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Telephone | 618-566-8810
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Fax | 618-566-7121
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES C ALTHOFF
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Credential | MD
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Telephone | 618-566-8810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042007909
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License Number State | IL
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