Proctor Community Hospital

Primary specialty

Psychiatric Hospital UnitTaxonomy code 273R00000X

License

0001925 Issued in IL

Legal business name

PROCTOR COMMUNITY HOSPITAL

Practice address

5409 N Knoxville Ave
Peoria, IL 61614-5069

Phone

(309) 691-1000

Fax

(309) 671-8265

NPI assigned

Jul 30, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Deborah R. Simon

Title

Presidentceo

Phone

(309) 672-5928

Specialties & licenses 2

Addresses

Other names 1

• Proctor Hospital Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1134475940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5409 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145069",
            "telephone_number": "309-672-4813",
            "fax_number": "309-671-8265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5409 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145069",
            "telephone_number": "309-691-1000",
            "fax_number": "309-671-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCTOR COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-30",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENTCEO",
        "authorized_official_telephone_number": "309-672-5928",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "IL",
            "license": "2087309",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "IL",
            "license": "0001925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proctor Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James G. Priepot, M.D.
• Prime Care Services LLC
• Mandie Geneil Prior, DO
• Jacob Ryan Pritchard, LCPC
• Proctor Community Hospital
• Proctor Community Hospital
• Proctor Community Hospital
• Proctor Community Hospital
• Proctor Community Hospital
• Proctor Community Hospital

• All providers in Peoria, IL
• Psychiatric Hospital Unit in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.