Healthcare Provider Details

I. General information

NPI: 1760940860
Provider Name (Legal Business Name): PANA COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S LOCUST ST
PANA IL
62557-1689
US

IV. Provider business mailing address

217 S LOCUST ST
PANA IL
62557-1605
US

V. Phone/Fax

Practice location:
  • Phone: 217-562-2143
  • Fax: 217-562-2251
Mailing address:
  • Phone: 217-562-2143
  • Fax: 217-562-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORI ANNE ADE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 217-562-2143