Provider Demographics
NPI:1326408204
Name:JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Other - Org Name:PERRY MEMORIAL PROMPT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL STAFF SERVICES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-876-2293
Mailing Address - Street 1:530 PARK AVE E
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-3901
Mailing Address - Country:US
Mailing Address - Phone:815-876-4419
Mailing Address - Fax:815-876-4455
Practice Address - Street 1:2128 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-9728
Practice Address - Country:US
Practice Address - Phone:815-875-2273
Practice Address - Fax:815-207-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001883261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care