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General NPI Number Information
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NPI Number | 1720223837
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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 | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 5401 N KNOXVILLE AVE STE 217
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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 | 309-691-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE STE 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 | 309-691-1092
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Fax | 309-689-6092
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Authorized Official
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Title or Position | SYSTEM ANALYST
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Name | DENISE BRINKER
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Credential |
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Telephone | 390-689-6089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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