# ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SSM Health St. Mary's Hospital - Centralia
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477097871
- **Authorized official:** MR. TIM BULLER CFO (REGIONAL CFO)
- **Authorized official phone:** (314) 989-2492

## Contact information

- **Practice address:** 400 N PLEASANT AVE, CENTRALIA, IL 62801-3056
- **Practice address phone:** (618) 436-6056
- **Practice address fax:** (618) 532-9365
- **Mailing address:** 1145 CORPORATE LAKE DR, SAINT LOUIS, MO 63132-2907
- **Mailing address phone:** (314) 989-2492
- **Mailing address fax:** (314) 344-7281

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 0002642 | IL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 0002642 | IL | — |

## Other

- **Enumeration date:** 12/05/2016
- **Last updated:** 03/26/2018