Organization
PASSAVANT MEMORIAL AREA HOSPITAL
Active
Other names
PASSAVANT SURGICAL ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY RAGEL (CFO/VICE PRESIDENT OF FINANCE)
(217) 479-5527
Entity
Organization
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 479-5821
(217) 243-7406
Mailing address
PO BOX 1977, SPRINGFIELD, IL 62705-1977
(217) 544-6464
(217) 757-6021
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06932023
BLUE CROSS BLUE SHIELD
IL
01
—
752951
HEALTHLINK
IL
01
—
CB3741
RR MEDICARE GROUP#
IL
Enumeration date
06/15/2006
Last updated
07/21/2022
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