Healthcare Provider Details

I. General information

NPI: 1396106910
Provider Name (Legal Business Name): PANA COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N. WALNUT
ASSUMPTION IL
62510-1082
US

IV. Provider business mailing address

118 N. WALNUT
ASSUMPTION IL
62510-1082
US

V. Phone/Fax

Practice location:
  • Phone: 217-226-3133
  • Fax: 217-226-4311
Mailing address:
  • Phone: 217-226-3133
  • Fax: 217-226-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS LISA BLOEMER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 217-562-6246