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. STEPHEN G LEE (PRACTICE MANAGER)
(217) 479-5890
Entity
Organization
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 243-8455
(217) 243-7951
Mailing address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 243-8455
(217) 243-7951
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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