Proctor Medical Group Renaldo Jacques Md

LBN: Proctor Health Systems
Proctor Medical Group Renaldo Jacques Md is an health care organization with primary practice located at 5401 N Knoxville Ave Ste 306 , Peoria IL 61614-5021. The organization recently has only one registered license in Ambulatory Health Care Facilities / Clinic/Center, which is considered as the primary health care specialty. Proctor Health Systems can be contacted via phone (309) 691-0027, or through Chiaravalle, Carrie via phone (309) 689-6043.

Contact Information

Primary practice address
5401 N Knoxville Ave Ste 306 Peoria IL 61614-5021
Phone: (309) 691-0027
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Chiaravalle, Carrie
Phone: (309) 689-6043

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Clinic/Center 261Q00000X

Profile Details

NPI number 1396923702
LBN Legal business name Proctor Health Systems
DBA Doing business as Proctor Medical Group Renaldo Jacques Md
Authorized official Chiaravalle, Carrie
Entity Organization
Organization subpart 1 No
Enumeration date Feb 7th, 2008
Last updated Feb 7th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396923702 NPPES
Illinois Other 07232122 BCBSIL

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