PASSAVANT PHYSICIAN ASSOCIATION
NPI 1962689307
Clinic/Center - Multi-Specialty in Jacksonville, IL

Q: What is Passavant Physician Association's NPI number?

The NPI number for Passavant Physician Association is 1962689307. It was assigned to this organization in the NPPES registry on January 29, 2008.

Q: What is Passavant Physician Association's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Active since January 29, 2008

1600 W WALNUT ST, JACKSONVILLE, IL 62650(217) 479-5890(217) 243-2206 Get Directions Write a Review

NPPES record last updated: March 21, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 21, 2018, Sep 28, 2016 (2 updates tracked since 2016).

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About Passavant Physician Association NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PASSAVANT PHYSICIAN ASSOCIATION (NPI 1962689307) is a healthcare organization registered as a multi-specialty in Jacksonville, Illinois and active in the NPI registry since January 2008. The organization lists Wendi D Graham, Practice Plan Administrator, as its authorized official.

NPPES Registry Identity

NPI1962689307

Entity TypeOrganization

Primary Taxonomy261QM1300X

Legal Business NamePASSAVANT PHYSICIAN ASSOCIATION

Location Address1600 W WALNUT STJacksonville, IL 62650-1136

Mailing Address1600 W Walnut StJacksonville, IL 62650-1136 · (217) 479-5890 · Fax (217) 479-5677

Phone(217) 479-5890

Fax(217) 243-2206

Organization SubpartNo

Authorized OfficialWendi D GrahamPractice Plan Administrator · (217) 479-5663

Enumeration DateJanuary 29, 2008

Last NPPES UpdateMarch 21, 20182 updates tracked since enumeration

✔ NPI 1962689307 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 9

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities

Taxonomy Code261QM1300X

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedObstetrics & Gynecology · ObstetricsTaxonomy 207VX0000X · License 036048526 (IL)

Also ListedOtolaryngologyTaxonomy 207Y00000X · License 036057937 (IL)

Also ListedPreventive Medicine · Undersea and Hyperbaric MedicineTaxonomy 2083P0011X

Also ListedSurgeryTaxonomy 208600000X

Also ListedAudiologistTaxonomy 231H00000X

Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X

1600 W WALNUT ST, Jacksonville, IL 62650

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Other Identifiers 3

OtherDH1383IL · Railroad Ptan

OtherIL2621IL · 2nd Location Medicare Pin #

Other6932023IL · Bcbs

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEALTHCARE NETWORK ASSOCIATES

Clinic/Center (Multi-Specialty)