PASSAVANT PHYSICIAN ASSOCIATION NPI 1972054609

NPI Information

NPI: 1972054609
Provider Name: PASSAVANT PHYSICIAN ASSOCIATION
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
559 N WESTGATE AVE
JACKSONVILLE, IL
ZIP 62650
Phone: (217) 243-5474
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PASSAVANT PHYSICIAN ASSOCIATION is a rural health clinic center in Jacksonville, IL. PASSAVANT PHYSICIAN ASSOCIATION NPI is 1972054609. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

559 N WESTGATE AVE
JACKSONVILLE, IL
ZIP 62650-156
Phone: (217) 243-5474
Fax: (217) 245-2322

The provider's authorized official is Robert Ellison .
The authorized official title is Director and has the following contact phone number (217) 479-5890.

The enumeration date for this NPI number is 10/18/2016 and was last updated on 4/4/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207Q00000X	Family Medicine		No
2	207R00000X	Internal Medicine		No
3	207Y00000X	Otolaryngology		No
4	261QR1300X	Clinic/Center	Rural Health	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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