# PASSAVANT PHYSICIAN ASSOCIATION

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

## Provider details

- **NPI number:** 1972054609
- **Legal business name:** PASSAVANT MEMORIAL AREA HOSPITAL
- **Authorized official:** MR. ROBERT ELLISON (DIRECTOR)
- **Authorized official phone:** (217) 479-5890

## Contact information

- **Practice address:** 559 N WESTGATE AVE, JACKSONVILLE, IL 62650-1156
- **Practice address phone:** (217) 243-5474
- **Practice address fax:** (217) 245-2322
- **Mailing address:** 559 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 |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |

## Other

- **Enumeration date:** 10/18/2016
- **Last updated:** 04/04/2017