Julia Rackley Perry Memorial Hospital

Key facts

NPI: 1699229823
Entity type: Organization (NPI type 2)
Primary specialty: Rural Health Clinic/Center 261QR1300X
License: 0001883 (IL)
Legal business name: JULIA RACKLEY PERRY MEMORIAL HOSPITAL
Practice address: 2128 N Main St
Princeton, IL 61356-9728
Phone: (815) 875-2273
Fax: (815) 207-8682
NPI assigned: Aug 4, 2016
Organization subpart: Yes
Parent organization (as reported): JULIA RACKLEY PERRY MEMORIAL HOSPITAL

Authorized official

Name: Jean Welte
Title: Medical Staff Services Coord
Phone: (815) 876-2293

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Julia Rackley Perry Memorial Hospital Durable Medical Equipment & Medical Supplies · Princeton, IL · NPI 1891726253

NPD member Member Of

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Name	Role	Since	Share
Gary Bruce Individual	Corporate Director Board Member	Oct 20, 2003
Julia Rackley Perry Memorial Hospital Organization · Princeton, IL	5% Or Greater Direct Ownership Interest	Aug 25, 2014	100%
Anthony Sorcic Individual	Corporate Officer Vice-Chairman	Nov 4, 2002
Linda Gustafson Individual	Corporate Officer Secretary	Oct 6, 2003
Thomas Tester Individual	Corporate Director Board Member	Jul 7, 1997
Gregg E Davis Individual	Corporate Director Board Member	Apr 18, 2011
Rick Clary Individual	Corporate Officer Chairman	Oct 1, 2001
Scott a Hartman Individual	Corporate Officer Interim Ceo	Mar 1, 2021
Scott a Hartman Individual	W-2 Managing Employee Interim Ceo	Mar 1, 2021

National Provider Directory

Part of: Perry Mem Hosp Cardiolo

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Rural Health Clinic/Center	261QR1300X	0001883	IL	Yes

Addresses

Primary practice location

2128 N Main St
Princeton, IL 61356-9728

Mailing address

530 Park Ave E
Princeton, IL 61356-3901
Phone (815) 876-4419

Other names

Perry Memorial Prompt Care Doing business as

Other providers in Princeton, IL

All providers in Princeton, IL · Rural Health Clinic/Center in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.