Organization
ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Active
Other names
Lake Shore Urology at St. Mary's
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
1770 E LAKE SHORE DR, SUITE 202, DECATUR, IL 62521-3832
(217) 464-2505
(217) 464-1669
Mailing address
3051 HOLLIS DR, SPRINGFIELD, IL 62704-7450
(217) 464-2505
(217) 464-1669
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
05/02/2008
Last updated
10/31/2024
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