Provider Demographics
NPI:1619215860
Name:PANA COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:PANA COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:COMMUNITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE 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:217-562-6246
Mailing Address - Street 1:101 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1716
Mailing Address - Country:US
Mailing Address - Phone:217-562-6246
Mailing Address - Fax:217-562-6228
Practice Address - Street 1:101 E 9TH ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1716
Practice Address - Country:US
Practice Address - Phone:217-562-6246
Practice Address - Fax:217-562-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
148508Medicare UPIN
IL814700Medicare UPIN