JULIA RACKLEY PERRY MEMORIAL HOSPITAL (NPI# 1265759393) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265759393 |
| Entity Type | Organization |
| Organization Name | JULIA RACKLEY PERRY MEMORIAL HOSPITAL |
| Other Organization Name | PERRY MEMORIAL CLINIC FOR WOMEN'S HEALTH |
| Practice Address |
530 Park Ave E Suite 201 Princeton IL 61356-3901 |
| Practice Telephone | 8158752811 |
| Mailing Telephone | 8158752811 |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2010-04-29 |
| Authorized Official Name | REX D CONGER (CEO) |
| Authorized Official Telephone | 8158762234 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Perry Memorial Clinic for Women's Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932610110 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 530 Park Ave E Fl 3, Princeton, IL 61356-3901 | 2017-10-16 |
| 1578083051 | Julia Rackley Perry Memorial Hospital | Surgery | 530 Park Ave E Ste 205, Princeton, IL 61356-3902 | 2017-06-26 |
| 1629598602 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 327 Edward St, Henry, IL 61537-1539 | 2017-06-21 |
| 1033649967 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 105 N Main St Ste 1, Walnut, IL 61376-9707 | 2017-06-13 |
| 1124021308 | Julia Rackley Perry Memorial Hospital | General Acute Care Hospital | 530 Park Ave E, Princeton, IL 61356-3901 | 2005-05-23 |
| 1134695422 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 327 Edward St, Henry, IL 61537-1539 | 2018-10-15 |
| 1043786338 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 105 N Main St Ste 1, Walnut, IL 61376-9707 | 2018-10-15 |
| 1952877243 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 530 Park Ave E Ste 303, Princeton, IL 61356-3903 | 2018-10-15 |
| 1699229823 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 2128 N Main St, Princeton, IL 61356-9728 | 2016-08-04 |
| 1326408204 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 2128 N Main St, Princeton, IL 61356-9728 | 2016-03-04 |
| Street Address |
530 PARK AVE E SUITE 201 |
| City | PRINCETON |
| State | IL |
| Zip Code | 61356-3901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124021308 | Julia Rackley Perry Memorial Hospital | General Acute Care Hospital | 530 Park Ave E, Princeton, IL 61356-3901 | 2005-05-23 |
| 1427529577 | Ashley Kannenberg | Dietitian, Registered | 530 Park Ave E, Princeton, IL 61356-2598 | 2018-12-16 |
| 1689126799 | Jo A Muller | Nurse Practitioner | 530 Park Ave E, Ste 207, Princeton, IL 61356-3901 | 2016-10-25 |
| 1578940524 | Jennifer Hoffman | Nurse Practitioner | 530 Park Ave E, Princeton, IL 61356-3901 | 2015-04-29 |
| 1114326956 | Ketan R Patel | Internal Medicine | 530 Park Ave E, Suite 101, Princeton, IL 61356-3901 | 2014-08-18 |
| 1922411602 | Julia Rackley Perry Memorial Hospital | Clinic/Center | 530 Park Ave E, Princeton, IL 61356-3901 | 2014-06-10 |
| 1942551312 | Jenny Gaworski | Nurse Practitioner | 530 Park Ave E, Princeton, IL 61356-3901 | 2012-09-26 |
| 1619231719 | Victoria Jeannine Anderson | Physical Therapy Assistant | 530 Park Ave E, Princeton, IL 61356-2598 | 2012-07-03 |
| 1710241286 | Jacquelyn Johnson | Occupational Therapist | 530 Park Ave E, Princeton, IL 61356-3901 | 2012-06-29 |
| 1023372869 | Debra K Austin | Physical Therapist | 530 Park Ave E, Princeton, IL 61356-2598 | 2012-06-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548698558 | Shelley Gorenz | Counselor | 1009 S. Main St., Princeton, IL 61356 | 2013-10-30 |
| 1780016626 | Jennifer Phillips | Pharmacist | 610 N. Main St., Princeton, IL 61356 | 2013-08-02 |
| 1477848521 | Princeton Prompt Care LLC | Clinic/Center | 2128 North Main Street, Princeton, IL 61356 | 2011-06-16 |
| 1306014196 | Lifefit Physical Rehab, Ltd. | Clinic/Center | 1225 N. Sixth St., Princeton, IL 61356 | 2008-02-14 |
| 1568669778 | Hawthorne Inn Supportive Living Facility | Assisted Living Facility | 136 N. Sixth St., Princeton, IL 61356 | 2007-06-29 |
| 1720209240 | Michelle Lee Mortensen | Music Therapist | 816 S. First St., Princeton, IL 61356 | 2007-05-01 |
| 1073733465 | Jarred Allen Farrell | Chiropractor | 682 East Peru Street, Princeton, IL 61356 | 2007-04-26 |
| 1952488397 | Donald R Marion | Optometrist | 2 Park Avenue West, Princeton, IL 61356 | 2006-11-01 |
| 1427138247 | Bruce Waldo Shriver | Dentist | 422 E Peru St, Princeton, IL 61356 | 2006-10-16 |
| 1871689612 | Jason A Monroe | Dentist | 334 Backbone Rd East, Princeton, IL 61356 | 2006-10-05 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104250117 | Charlsie Khalisha Celestine | Obstetrics & Gynecology | 800 Bunn Dr Ste 202, Princeton, NJ 08540-1968 | 2013-08-27 |
| 1790045821 | Brandon M Lingenfelter | Obstetrics & Gynecology | 411 12th Street Ext, Princeton, WV 24740-2300 | 2012-05-23 |
| 1134268816 | A Princeton Women's Center, P.C. | Obstetrics & Gynecology | 29 Emmons Dr Ste E20, Princeton, NJ 08540-5919 | 2007-02-06 |
| 1770638900 | Jeffrey Hofman | Obstetrics & Gynecology | 601 Ewing St., Suite C-13, Princeton, NJ 08540-2758 | 2007-01-25 |
| 1598828931 | Judith Forster | Obstetrics & Gynecology | 114 Stanhope St, Princeton, NJ 08540-5756 | 2006-12-18 |
| 1215096805 | Womens Healthcare of The Virginias LLC | Obstetrics & Gynecology | 403 12th St Extension, Princeton, WV 24740 | 2006-12-08 |
| 1093805392 | Joe Carey Ellington Jr. | Obstetrics & Gynecology | 112 Undercliff Ter, Princeton, WV 24740-2174 | 2006-10-15 |
| 1871511642 | Thomas C Tsai | Obstetrics & Gynecology | 52 Worths Mill Ln, Princeton, NJ 08540-7319 | 2006-07-18 |
| 1285660183 | Heather M Van Raalte | Obstetrics & Gynecology | 10 Forrestal Rd S, Suite 205, Princeton, NJ 08540-6666 | 2006-06-23 |
| 1992338701 | Garden State Medical Practice, PC | Obstetrics & Gynecology | 16 Chambers St, Princeton, NJ 08542-3708 | 2020-02-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.