Provider Demographics
NPI:1356057301
Name:PROCTOR HEALTH SYSTEMS
Entity type:Organization
Organization Name:PROCTOR HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEPP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:309-671-2528
Mailing Address - Street 1:221 NE GLEN OAK AVE # GOMP100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61636-0001
Mailing Address - Country:US
Mailing Address - Phone:309-672-4874
Mailing Address - Fax:
Practice Address - Street 1:223 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:61559-9654
Practice Address - Country:US
Practice Address - Phone:309-385-4371
Practice Address - Fax:309-385-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty