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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. ROBERT ELLISON (DIRECTOR)
(217) 479-5890
Entity
Organization
Contact information
Practice address
559 N WESTGATE AVE, JACKSONVILLE, IL 62650-1156
(217) 243-5474
(217) 245-2322
Mailing address
559 N WESTGATE AVE, JACKSONVILLE, IL 62650-1156
(217) 243-5474
(217) 245-2322
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/18/2016
Last updated
04/04/2017
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