Healthcare Provider Details

I. General information

NPI: 1619934833
Provider Name (Legal Business Name): JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PARK AVE E
PRINCETON IL
61356-3901
US

IV. Provider business mailing address

530 PARK AVE E
PRINCETON IL
61356-3901
US

V. Phone/Fax

Practice location:
  • Phone: 815-875-2811
  • Fax: 815-876-4455
Mailing address:
  • Phone: 815-875-2811
  • Fax: 815-876-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEAN WELTE
Title or Position: MEDICAL STAFF SERVICES COORDINATOR
Credential:
Phone: 815-876-2293