Provider Demographics
NPI:1578083051
Name:JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Other - Org Name:PERRY MEMORIAL GENERAL SURGERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHNABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-876-2236
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 1:530 PARK AVE E STE 205
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-3902
Practice Address - Country:US
Practice Address - Phone:815-872-9491
Practice Address - Fax:815-875-4060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001883208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty