Provider Demographics
NPI:1114388733
Name:PANA COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:PANA COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:COMMUNITY MEDICAL CLINIC OF NOKOMIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-562-6246
Mailing Address - Street 1:120 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:IL
Mailing Address - Zip Code:62075-1647
Mailing Address - Country:US
Mailing Address - Phone:217-563-8363
Mailing Address - Fax:217-563-8373
Practice Address - Street 1:120 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:IL
Practice Address - Zip Code:62075-1647
Practice Address - Country:US
Practice Address - Phone:217-563-8363
Practice Address - Fax:217-563-8373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEDICAL CLINIC OF NOKOMIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty