Provider Demographics
NPI:1760994040
Name:PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
Other - Org Name:PASSAVANT PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PATIENT FINCNAIAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SILTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-479-5652
Mailing Address - Street 1:1600 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1136
Mailing Address - Country:US
Mailing Address - Phone:217-245-9541
Mailing Address - Fax:217-479-8781
Practice Address - Street 1:1600 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1136
Practice Address - Country:US
Practice Address - Phone:217-245-9541
Practice Address - Fax:217-479-8781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-26
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty