Provider Demographics
NPI:1437103231
Name:PROCTOR HEALTH SYSTEMS
Entity Type:Organization
Organization Name:PROCTOR HEALTH SYSTEMS
Other - Org Name:ASSOCIATED FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDBEESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-697-2416
Mailing Address - Street 1:1506 W GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-1755
Mailing Address - Country:US
Mailing Address - Phone:309-697-2416
Mailing Address - Fax:309-697-2749
Practice Address - Street 1:1506 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-1755
Practice Address - Country:US
Practice Address - Phone:309-698-2416
Practice Address - Fax:309-697-2749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROCTOR HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242900Medicare ID - Type Unspecified