Passavant Physician Association
Clinic/Center, Multi-Specialty in Jacksonville, IL. Organization (NPI-2).
NPI number1962689307
StatusActive
Last updated in NPPESMar 21, 2018
Details
- NPI
- 1962689307
- Entity type
- Organization (NPI-2)
- Legal business name
- Passavant Physician Association
- Organization subpart
- No
- Enumeration date
- Jan 29, 2008
- Last updated
- Mar 21, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | Yes |
| 207Q00000X | Family Medicine | – | – | |
| 208600000X | Surgery | – | – | |
| 207R00000X | Internal Medicine | – | – | |
| 207VX0000X | Obstetrics & Gynecology, Obstetrics | 036048526 | IL | |
| 207Y00000X | Otolaryngology | 036057937 | IL | |
| 2083P0011X | Preventive Medicine, Undersea and Hyperbaric Medicine | – | – | |
| 231H00000X | Audiologist | – | – | |
| 363LA2200X | Nurse Practitioner, Adult Health | – | – |
Practice location
1600 W Walnut StJacksonville, IL 62650-1136
Phone 217-479-5890 · Fax 217-243-2206
Mailing address
1600 W Walnut StJacksonville, IL 62650-1136
Phone 217-479-5890 · Fax 217-479-5677
Authorized official
Wendi D Graham
Practice Plan Administrator
2174795663
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Other Multi-Specialty Clinic/Center providers in Jacksonville, IL
- Healthcare Network AssociatesNPI 1003979360
- Healthcare Network AssociatesNPI 1124181482
- Healthcare Network AssociatesNPI 1922161280
- Passavant Memorial Area Hospital AssociationNPI 1235864810
All 5 Multi-Specialty Clinic/Center providers in Jacksonville · All 515 providers in Jacksonville
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