MEDICARE: PROCTOR HEALTH SYSTEMS

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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1740234533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCTOR HEALTH SYSTEMS

Provider Business Mailing Address
First Line	:	5401 N KNOXVILLE AVE
Second Line	:	SUITE 209
City	:	PEORIA
State	:	IL
Zip	:	61614-5098
Country	:	US
Telephone Number	:	309-689-6049
Fax Number	:	309-689-6092

Provider Business Practice Location Address
First Line	:	210 N 4TH ST
Second Line	:
City	:	CHILLICOTHEE
State	:	IL
Zip	:	61523-2058
Country	:	US
Telephone Number	:	309-274-2108
Fax Number	:	309-274-6920

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CARRIE CHIARAVALLE
Credential	:
Telephone Number	:	309-689-6049

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/26/2008

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Directions to “PROCTOR HEALTH SYSTEMS ” Practice Location

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