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NPI Code Detail

MEDICARE: CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION

MEDICARE: CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2207Q00000XFamily Medicine Physician
3207V00000XObstetrics & Gynecology Physician
4363A00000XPhysician Assistant
5261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1619957297
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Provider Business Mailing Address
First Line : PO BOX 155
Second Line :
City : CHRISTOPHER
State : IL
Zip : 62822-0155
Country : US
Telephone Number : 618-724-2401
Fax Number : 618-724-4628
Provider Business Practice Location Address
First Line : 1564 S WASHINGTON ST
Second Line :
City : DU QUOIN
State : IL
Zip : 62832-3849
Country : US
Telephone Number : 618-542-8702
Fax Number : 618-542-8792
Authorized Official
Title or Position : PRESIDENT CEO
Name : KIM A MITROKA
Credential :
Telephone Number : 618-724-2436
Provider Enumeration Date : 01/19/2006
Last Update Date : 01/19/2026

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