Passavant Physician Association
NPI #1841578507 in Jacksonville, Illinois
Provider Information
- NPI Number
- 1841578507
- Entity Type
- Organization
- Organization Name
- Passavant Physician Association
- Primary Specialty
- Family Medicine
- Enumeration Date
- Jul 29, 2011
- Last Updated
- Jul 29, 2011
Practice Location
- Address
- 1600 W WALNUT ST
- City
- Jacksonville
- State
- Illinois
- ZIP Code
- 62650-1136
- Phone
- (217) 245-9541
Authorized Official
- Name
- MR. STEPHEN G LEE
- Title
- PLAN ADMINISTRATOR
- Phone
- (217) 479-5890
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Adult Health — Adult Health |
| Family Medicine |
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