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Organization
PROCTOR HEALTH SYSTEMS
Active
Organization
PROCTOR HEALTH SYSTEMS
Active
Other names
PROCTOR MEDICAL GROUP RENALDO JACQUES MD
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE CHIARAVALLE (DIRECTOR OPERATIONS)
(309) 689-6043
Entity
Organization
Contact information
Practice address
5401 N KNOXVILLE AVE STE 306, PEORIA, IL 61614-5021
(309) 691-0027
Mailing address
5401 N KNOXVILLE AVE STE 306, PEORIA, IL 61614-5021
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07232122
BCBSIL
IL
Enumeration date
02/07/2008
Last updated
02/07/2008
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