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Organization
ST MARYS HOSPITAL
Active
Organization
ST MARYS HOSPITAL
Active
Parent organization
ST MARYS HOSPITAL
Other names
St Marys Orthopedics
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST MARYS HOSPITAL
Authorized official
KAREN S CLARK (CFO)
(815) 673-4514
Entity
Organization
Contact information
Practice address
104 W 6TH ST, STREATOR, IL 61364-2899
(815) 673-3223
(815) 673-3305
Mailing address
104 W 6TH ST, STREATOR, IL 61364-2899
(815) 673-3223
(815) 673-3305
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036070970
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070970
—
IL
01
—
1164673307
BLUESHIELD
IL
01
—
1659330090
MD NPI
—
01
—
9924600
CIGNA
IL
Enumeration date
10/07/2008
Last updated
04/22/2009
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