# ST. MARY'S HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST. MARY'S HOSPITAL
- **Other names:** St. Mary's Vascular and Thoracic Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1598946543
- **Legal business name:** ST. MARY'S HOSPITAL
- **Authorized official:** KAREN S CLARK (CFO)
- **Authorized official phone:** (815) 673-4514

## Contact information

- **Practice address:** 104 E BRIDGE ST, STREATOR, IL 61364-2967
- **Practice address phone:** (815) 672-4015
- **Mailing address:** 104 E BRIDGE ST, STREATOR, IL 61364-2967
- **Mailing address phone:** (815) 672-4015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 036078501 | IL | Yes |

## Other

- **Enumeration date:** 11/19/2007
- **Last updated:** 05/13/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1548281926 | MD NPI | — |
| 05 | — | 36121627 | — | IL |
| 01 | — | 5032121 | BLUESHIELD | IL |
| 01 | — | IL1789 | MEDICARE GROUP | IL |