# PASSAVANT PHYSICIAN ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PASSAVANT MEMORIAL AREA HOSPITAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205387958
- **Legal business name:** PASSAVANT MEMORIAL AREA HOSPITAL
- **Authorized official:** MR. STEPHEN G LEE (PRACTICE MANAGER)
- **Authorized official phone:** (217) 479-5890

## Contact information

- **Practice address:** 1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
- **Practice address phone:** (217) 243-8455
- **Practice address fax:** (217) 243-7951
- **Mailing address:** 1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
- **Mailing address phone:** (217) 243-8455
- **Mailing address fax:** (217) 243-7951

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/18/2016
- **Last updated:** 10/18/2016