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Organization
ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Active
Organization
ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Active
Other names
ILLINI SPORTS MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D EVARD (VP OF REVENUE CYCLE)
(217) 492-9651
Entity
Organization
Contact information
Practice address
301 W LINCOLN ST, SUITE 210, BELLEVILLE, IL 62220-1901
(618) 641-5800
(618) 641-5825
Mailing address
3051 HOLLIS DR, SPRINGFIELD, IL 62704-7450
(618) 641-5800
(618) 641-5825
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Enumeration date
07/25/2006
Last updated
10/31/2024
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