# PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jacksonville Professional Fees
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235864810
- **Authorized official:** ANN BOWLING (DIRECTOR)
- **Authorized official phone:** (217) 588-2626

## Contact information

- **Practice address:** 1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
- **Practice address phone:** (217) 245-9541
- **Mailing address:** PO BOX 3428, SPRINGFIELD, IL 62708-3428
- **Mailing address phone:** (217) 245-9541
- **Mailing address fax:** (217) 757-7550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | — | — | — |
| 2085R0001X | Radiation Oncology Physician | — | NULL | — |
| 2085R0001X | Radiation Oncology Physician | — | — | — |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 07/19/2022
- **Last updated:** 01/09/2024