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
—
—
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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