Organization
ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Active
Other names
ELDERMED SERVICES
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
1512 N GREEN MOUNT RD, SUITE 200, O FALLON, IL 62269-1953
(618) 234-2120
(618) 222-4703
Mailing address
3051 HOLLIS DR, SPRINGFIELD, IL 62704-7450
(618) 234-2120
(618) 222-4703
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036115149
INTERNAL MEDICINE
IL
Enumeration date
01/03/2008
Last updated
10/31/2024
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