NPIMap

Organization Active NPI

Passavant Physician Association

  • Rural Health Clinic/Center
  • Jacksonville, IL
National Provider Identifier
1922410836
Registry record updated Jun 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PASSAVANT PHYSICIAN ASSOCIATION
Practice address
557 N Westgate Ave
Jacksonville, IL 62650-1156
Phone
(217) 243-5474
Fax
(217) 245-2322
NPI assigned
May 27, 2014
Last updated
Jun 2, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Stephen G Lee
Title
Physician Services Officer
Phone
(217) 479-5890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

557 N Westgate Ave
Jacksonville, IL 62650-1156

Mailing address

557 N Westgate Ave
Jacksonville, IL 62650-1156
Phone (217) 243-5474

National Provider Directory

National Provider Directory
Tax ID family
Passavant Physician Association4 organizations share this tax ID, including this one
Part of
Passavant Area Hosp CRN

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401667200000",
    "number": "1922410836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 N WESTGATE AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501156",
            "telephone_number": "217-243-5474",
            "fax_number": "217-245-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 N WESTGATE AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501156",
            "telephone_number": "217-243-5474",
            "fax_number": "217-245-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAVANT PHYSICIAN ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION",
        "enumeration_date": "2014-05-27",
        "last_updated": "2014-06-02",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN SERVICES OFFICER",
        "authorized_official_telephone_number": "217-479-5890",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.