Organization
PASSAVANT MEMORIAL AREA HOSPITAL
Active
Parent organization
PRAIRIELAND EMERGENCY PHYSICIANS
Other names
PRAIRIELAND EMERGENCY PHYSICIANS
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRAIRIELAND EMERGENCY PHYSICIANS
Authorized official
MR. CHESTER A WYNN (CEO)
(217) 245-9541
Entity
Organization
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-9541
(217) 479-8781
Mailing address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-9541
(217) 479-8781
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
342729
HEALTHLINK ERPHY GROUP NU
IL
01
—
6921280
BLUE SHIELD
IL
01
—
CD9582
MEDICARE RAILROAD ERPHY G
IL
Enumeration date
06/15/2006
Last updated
07/21/2022
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