# PASSAVANT PHYSICIAN ASSOCIATION

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

## Provider details

- **NPI number:** 1922410836
- **Legal business name:** PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
- **Authorized official:** MR. STEPHEN G LEE (PHYSICIAN SERVICES OFFICER)
- **Authorized official phone:** (217) 479-5890

## Contact information

- **Practice address:** 557 N WESTGATE AVE, JACKSONVILLE, IL 62650-1156
- **Practice address phone:** (217) 243-5474
- **Practice address fax:** (217) 245-2322
- **Mailing address:** 557 N WESTGATE AVE, JACKSONVILLE, IL 62650-1156
- **Mailing address phone:** (217) 243-5474
- **Mailing address fax:** (217) 245-2322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/27/2014
- **Last updated:** 06/02/2014