Provider Demographics
NPI:1306941695
Name:REGIONAL FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:REGIONAL FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-932-3101
Mailing Address - Street 1:101 S GALENA AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:IL
Mailing Address - Zip Code:61491-1470
Mailing Address - Country:US
Mailing Address - Phone:309-695-6448
Mailing Address - Fax:309-695-6447
Practice Address - Street 1:101 S GALENA AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:IL
Practice Address - Zip Code:61491-1470
Practice Address - Country:US
Practice Address - Phone:309-695-6448
Practice Address - Fax:309-695-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid
IL148963Medicare PIN