PASSAVANT PHYSICIAN ASSOCIATION NPI 1962689307

NPI Information

NPI: 1962689307
Provider Name: PASSAVANT PHYSICIAN ASSOCIATION
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
1600 W WALNUT ST
JACKSONVILLE, IL
ZIP 62650
Phone: (217) 479-5890
Get Directions

PASSAVANT PHYSICIAN ASSOCIATION is a multi-specialty clinic center in Jacksonville, IL. PASSAVANT PHYSICIAN ASSOCIATION NPI is 1962689307. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1600 W WALNUT ST
JACKSONVILLE, IL
ZIP 62650-136
Phone: (217) 479-5890
Fax: (217) 243-2206

The provider's authorized official is Wendi D Graham .
The authorized official title is Practice Plan Administrator and has the following contact phone number (217) 479-5663.

The enumeration date for this NPI number is 1/29/2008 and was last updated on 3/21/2018.

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	License Number	License State	Primary
1	207Q00000X	Family Medicine				No
2	207R00000X	Internal Medicine				No
3	207VX0000X	Obstetrics & Gynecology	Obstetrics	036048526	ILLINOIS	No
4	207Y00000X	Otolaryngology		036057937	ILLINOIS	No
5	2083P0011X	Preventive Medicine	Undersea and Hyperbaric Medicine			No
6	208600000X	Surgery				No
7	231H00000X	Audiologist				No
8	261QM1300X	Clinic/Center	Multi-Specialty			Yes
9	363LA2200X	Nurse Practitioner	Adult Health			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	DH1383	OTHER	ILLINOIS	RAILROAD PTAN
2	IL2621	OTHER	ILLINOIS	2ND LOCATION MEDICARE PIN #
3	6932023	OTHER	ILLINOIS	BCBS

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: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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