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General NPI Number Information
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NPI Number | 1578515953
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Entity Type | Organization
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Legal Business Name | PROCTOR HEALTH SYSTEMS
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 202 S MAIN ST
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City | LACON
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State | IL
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Zip | 61540-1416
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Country | US
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Telephone | 309-246-2235
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Fax | 309-246-3879
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 209
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-689-6049
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Fax | 309-689-6092
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Authorized Official
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Title or Position | DIRECTOR
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Name | CARRIE CHIARAVALLE
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Credential |
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Telephone | 309-689-6049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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