Provider Demographics
NPI:1720710437
Name:PANA COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:PANA COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:COWDEN MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-562-2131
Mailing Address - Street 1:101 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1785
Mailing Address - Country:US
Mailing Address - Phone:217-562-2131
Mailing Address - Fax:217-562-6271
Practice Address - Street 1:209 E ELM ST
Practice Address - Street 2:
Practice Address - City:COWDEN
Practice Address - State:IL
Practice Address - Zip Code:62422-1041
Practice Address - Country:US
Practice Address - Phone:217-783-6565
Practice Address - Fax:217-783-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty