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Organization
PASSAVANT PHYSICIAN ASSOCIATION
Active
Organization
PASSAVANT PHYSICIAN ASSOCIATION
Active
Parent organization
PASSAVANT MEMORIAL AREA HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
PASSAVANT MEMORIAL AREA HOSPITAL
Authorized official
MR. STEPHEN G LEE (PRACTICE MANAGER)
(217) 479-5890
Entity
Organization
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 243-8455
(217) 243-7951
Mailing address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 243-8455
(217) 243-7951
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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