Provider Demographics
NPI:1275859902
Name:PROCTOR COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:PROCTOR COMMUNITY HOSPITAL
Other - Org Name:PROCTOR HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-691-1000
Mailing Address - Street 1:5409 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5069
Mailing Address - Country:US
Mailing Address - Phone:309-691-1000
Mailing Address - Fax:
Practice Address - Street 1:1401 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-6034
Practice Address - Country:US
Practice Address - Phone:563-355-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001925324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility