Organization
JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Active
Other names
Perry Home Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA ELLISON (CFO/VICE PRESIDENT)
(815) 876-4497
Entity
Organization
Contact information
Practice address
530 PARK AVE E, PRINCETON, IL 61356-3901
(815) 876-3068
Mailing address
530 PARK AVE E, PRINCETON, IL 61356-3901
(815) 876-3068
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
20300268
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
621311
BLUE CROSS BLUE SHIELD IL
IL
Enumeration date
07/05/2006
Last updated
04/02/2012
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