Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Passavant Physician Association

Organization Family Medicine Physician · NPI 1962689307

Passavant Physician Association is a Family Medicine Physician in Jacksonville, Illinois. Licensed in Illinois. Registered with an NPI since 2008.

Licensed in
IL
In the registry since
2008
Specialties on file
9
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Practice location Address checks out

1600 W Walnut St
Jacksonville, IL 62650-1136
Phone: (217) 479-5890
Fax: (217) 243-2206
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Multi-Specialty Clinic/Center (primary) Taxonomy 261QM1300X
Family Medicine Physician Taxonomy 207Q00000X
Internal Medicine Physician Taxonomy 207R00000X
Obstetrics Physician Taxonomy 207VX0000X · Licence 036048526 (IL)
Otolaryngology Physician Taxonomy 207Y00000X · Licence 036057937 (IL)
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician Taxonomy 2083P0011X
Surgery Physician Taxonomy 208600000X
Audiologist Taxonomy 231H00000X
Adult Health Nurse Practitioner Taxonomy 363LA2200X

Record details

NPI number1962689307
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Wendi Graham — Practice Plan Administrator · (217) 479-5663
NPI enumeratedJanuary 29, 2008
Last updated in NPPESMarch 21, 2018
Mailing address1600 W Walnut St, Jacksonville, IL 62650-1136

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