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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