Healthcare Provider Details

I. General information

NPI: 1740234533
Provider Name (Legal Business Name): PROCTOR HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N 4TH ST
CHILLICOTHEE IL
61523-2058
US

IV. Provider business mailing address

5401 N KNOXVILLE AVE SUITE 209
PEORIA IL
61614-5098
US

V. Phone/Fax

Practice location:
  • Phone: 309-274-2108
  • Fax: 309-274-6920
Mailing address:
  • Phone: 309-689-6049
  • Fax: 309-689-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARRIE CHIARAVALLE
Title or Position: DIRECTOR
Credential:
Phone: 309-689-6049