Provider Demographics
NPI:1740298280
Name:BEBOUT, ELIZABETH ANN (PAC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:BEBOUT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3008
Mailing Address - Street 2:COMMUNITY HEALTH & EMERGENCY SERVICES
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3008
Mailing Address - Country:US
Mailing Address - Phone:618-457-0450
Mailing Address - Fax:618-457-7329
Practice Address - Street 1:205 N MAIN ST
Practice Address - Street 2:HARRISBURG MEDICAL CLINIC
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946
Practice Address - Country:US
Practice Address - Phone:618-253-8450
Practice Address - Fax:618-253-8454
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant