NPIMap

Organization Active NPI

Proctor Community Hospital

Doing business as Proctor Hospital

  • Rehabilitation Clinic/Center
  • Peoria, IL
National Provider Identifier
1457679581
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
0001925 Issued in IL
Legal business name
PROCTOR COMMUNITY HOSPITAL
Doing business as
Proctor Hospital
Practice address
5409 N Knoxville Ave
Peoria, IL 61614-5069
Phone
(309) 691-1000
Fax
(309) 671-8265
NPI assigned
May 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Authorized official

Name
Ms. Deborah R. Simon
Title
President/Ceo
Phone
(309) 672-5928

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X 0001925 IL Primary
Substance Use Disorder Rehabilitation Hospital Unit 276400000X 1927324 IL

Addresses

Primary practice location

5409 N Knoxville Ave
Peoria, IL 61614-5069

Mailing address

5409 N Knoxville Ave
Peoria, IL 61614-5069
Phone (309) 672-4813

Other names 1

  • Proctor Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lacon Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676246400000",
    "number": "1457679581",
    "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": "2010-05-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "309-672-5928",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "IL",
            "license": "0001925",
            "primary": true
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "IL",
            "license": "1927324",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proctor Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Proctor Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; 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.