PASSAVANT PHYSICIAN ASSOCIATION


Address: 557 N Westgate Ave, Jacksonville, IL 62650-1156
Phone: 2172435474

PASSAVANT PHYSICIAN ASSOCIATION (NPI# 1922410836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1922410836
Entity Type Organization
Organization Name PASSAVANT PHYSICIAN ASSOCIATION
Practice Address 557 N Westgate Ave
Jacksonville
IL 62650-1156
Practice Telephone 2172435474
Practice Fax Number 2172452322
Mailing Telephone 2172435474
Mailing Fax Number 2172452322
Enumeration Date 2014-05-27
Last Update Date 2014-06-02
Authorized Official Name MR. STEPHEN G LEE (PHYSICIAN SERVICES OFFICER)
Authorized Official Telephone 2174795890
Is Organization Subpart Y
Parent Organization Name PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QR1300X Clinic/Center
Specialization: Rural Health
Ambulatory Health Care Facilities

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1205387958 Passavant Physician Association Obstetrics & Gynecology 1600 W Walnut St, Jacksonville, IL 62650-1136 2016-10-18
1972054609 Passavant Physician Association Family Medicine 559 N Westgate Ave, Jacksonville, IL 62650-1156 2016-10-18
1841578507 Passavant Physician Association Nurse Practitioner 1600 W Walnut St, Jacksonville, IL 62650-1136 2011-07-29
1720370778 Passavant Physician Association Internal Medicine 559 N Westgate Ave, Jacksonville, IL 62650-1156 2011-05-10
1962689307 Passavant Physician Association Family Medicine 1600 W Walnut St, Jacksonville, IL 62650-1136 2008-01-29

Office Location

Street Address 557 N WESTGATE AVE
City JACKSONVILLE
State IL
Zip Code 62650-1156

Providers in the same location

NPI Name Taxonomy Address Enumeration
1649210444 Passavant Memorial Area Hospital Social Worker 557 N Westgate Ave, Jacksonville, IL 62650-1156 2006-06-08
1942218219 Russell Guy Taylor Psychologist 557 N Westgate Ave, Jacksonville, IL 62650-1156 2006-08-03
1316955669 Shelley L Reither Counselor 557 N Westgate Ave, Jacksonville, IL 62650-1156 2006-08-03
1154339349 William R Tennill Social Worker 557 N Westgate Ave, Jacksonville, IL 62650-1156 2006-08-03
1841224185 Allison Marie Meisner Psychiatry & Neurology 557 N Westgate Ave, Jacksonville, IL 62650-1156 2006-07-11

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1134768708 Stephanie Lee Mabus Occupational Therapy Assistant 873 Gorve St, Jacksonville, IL 62650 2019-12-31
1285281071 Sharshon Pharmacy Inc Pharmacy 154 W Morton Ave, Jacksonville, IL 62650 2019-08-26
1992275499 Brittany Ruth Helmich Counselor 340 W. State St., Jacksonville, IL 62650 2018-11-28
1811391782 Rodney E. Overstreet Hearing Instrument Specialist 1521 W. Walnut, Jacksonville, IL 62650 2014-10-21
1407979818 Jan Ala Speech-Language Pathologist 1111 W Morton, Speechworks, Jacksonville, IL 62650 2007-04-09
1083787592 Eldon G Barrowes Dds & Assoc PC Dentist 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 2006-11-15
1194895979 Joseph J Kozma Internal Medicine 1440 West Walnut, Jacksonville, IL 62650 2006-11-08
1740350529 Susan Weller Dentist 1614 West Lafayette Avenue, Jackson, IL 62650 2006-11-08
1659467793 Shawn M Fry Family Medicine 610 N. Westgate, Jacksonville, IL 62650 2006-10-05
1518050061 Ward Richard Dunseth II Nurse Anesthetist, Certified Registered 1400 W Walnut, Jacksonville, IL 62650 2006-10-02
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Taxonomy Information

Taxonomy Code 261QR1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Rural Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1053804443 Siu Physicians & Surgeons, Inc Clinic/Center 610 N Westgate Ave, Jacksonville, IL 62650-1152 2018-06-11
1861991226 Jacksonville Hospital LLC Clinic/Center 203 Nacogdoches St Ste 280, Jacksonville, TX 75766-2444 2018-02-12
1205180056 Memorial Physician Services Clinic/Center 1600 W Walnut St, East Wing, 3rd Floor, Jacksonville, IL 62650-1136 2012-11-01
1104179415 Memorial Physician Services Clinic/Center 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 2012-10-24
1558614867 Memorial Physician Services Clinic/Center 15 Founders Ln, Suite 100, Jacksonville, IL 62650-3919 2012-10-24
1881947174 Memorial Physician Services Clinic/Center 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 2012-10-24
1821366170 East Texas Medical Center Jacksonville Clinic/Center 203 Nacogdoches St, Suite 280, Jacksonville, TX 75766-2444 2011-12-01
1598068793 Springfield Clinic LLP Clinic/Center 15 Founders Ln, Jacksonville, IL 62650-3919 2010-12-09
1619129897 Jacksonville, LLC Clinic/Center 1602 W Lafayette Ave, Jacksonville, IL 62650-1007 2008-10-21
1437301611 Jacksonville, LLC Clinic/Center 1606 W Lafayette Ave, Jacksonville, IL 62650-3707 2008-10-21
Find all providers in JACKSONVILLE

Competitor

Search similar providers

City JACKSONVILLE
Zip Code 62650

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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