Healthcare Provider Details

I. General information

NPI: 1497861330
Provider Name (Legal Business Name): PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W WALNUT ST
JACKSONVILLE IL
62650-1136
US

IV. Provider business mailing address

1600 W WALNUT ST
JACKSONVILLE IL
62650-1136
US

V. Phone/Fax

Practice location:
  • Phone: 217-245-9541
  • Fax: 217-479-8781
Mailing address:
  • Phone: 217-245-9541
  • Fax: 217-479-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. HARRY M SCHMIDT
Title or Position: PRESIDENT & CEO
Credential:
Phone: 217-245-9541