Provider Demographics
NPI:1487843959
Name:PANA COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:PANA COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:COMMUNITY MEDICAL CLINIC OF ASSUMPTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLOEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-562-2544
Mailing Address - Street 1:118 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ASSUMPTION
Mailing Address - State:IL
Mailing Address - Zip Code:62510-1082
Mailing Address - Country:US
Mailing Address - Phone:217-226-3133
Mailing Address - Fax:217-226-4311
Practice Address - Street 1:118 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:ASSUMPTION
Practice Address - State:IL
Practice Address - Zip Code:62510-1082
Practice Address - Country:US
Practice Address - Phone:217-226-3133
Practice Address - Fax:217-226-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL814700Medicare PIN