| Proctor Health Systems | |
|
1112 5th St Lacon IL 61540-1353 | |
| (309) 246-2416 | |
| (309) 246-3574 |
| Full Name | Proctor Health Systems |
|---|---|
| Speciality | Clinic/Center |
| Location | 1112 5th St, Lacon, Illinois |
| Authorized Official Name and Position | Keith Knepp (CEO) |
| Authorized Official Contact | 3096712528 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proctor Health Systems 221 Ne Glen Oak Ave # Gomp100 Peoria IL 61636-0001 Ph: (309) 672-4874 | Proctor Health Systems 1112 5th St Lacon IL 61540-1353 Ph: (309) 246-2416 |
| NPI Number | 1477269421 |
|---|---|
| Provider Enumeration Date | 01/24/2023 |
| Last Update Date | 01/24/2023 |
| Medicare PECOS PAC ID | 3476440173 |
|---|---|
| Medicare Enrollment ID | O20230314002048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477269421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Kathleen M Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669422135 PECOS PAC ID: 2466430467 Enrollment ID: I20040707001289 |
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