Organization
PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
Active
Other names
Jacksonville Professional Fees
Organization subpart
No
Provider details
NPI number
Authorized official
ANN BOWLING (DIRECTOR)
(217) 588-2626
Entity
Organization
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-9541
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(217) 245-9541
(217) 757-7550
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
208M00000X
Hospitalist Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
07/19/2022
Last updated
01/09/2024
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