Organization Name: | PROCTOR HEALTH SYSTEMS |
NPI Number: | 1629022447 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARRIE CHIARAVALLE (DIRECTOR) |
Mailing Address: | 12315 N Knoxville Ave Dunlap |
State: | IL US |
Postal Code: | 615259501 |
Phone Number: | 3092435575 |
Fax Number: | 3092435764 |
NPI Enumeration Date: | 05/19/2006 |
NPI Last Update Date: | 08/07/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |