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General NPI Number Information
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NPI Number | 1578922050
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Entity Type | Organization
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Legal Business Name | JULIA RACKLEY PERRY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 535 PARK AVE E
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City | PRINCETON
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State | IL
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Zip | 61356-3901
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Country | US
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Telephone | 815-875-4531
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Fax | 815-876-2118
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Provider Business Mailing Address
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Address Line | 535 PARK AVE E
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City | PRINCETON
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State | IL
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Zip | 61356-3901
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Country | US
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Telephone | 815-875-4531
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Fax | 815-876-2118
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Authorized Official
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Title or Position | MEDICAL STAFF SERVICES COORDINATOR
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Name | JEAN WELTE
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Credential |
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Telephone | 815-876-2293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 0001883
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License Number State | IL
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