Organization
ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS
Active
Other names
SSM Health St. Mary's Hospital - Centralia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAMON R HARBISON (PRESIDENT)
(618) 436-8000
Entity
Organization
Contact information
Practice address
400 N PLEASANT AVE, CENTRALIA, IL 62801
(618) 436-8000
Mailing address
1195 CORPORATE LAKE DR, SAINT LOUIS, MO 63132-1716
(314) 989-3524
(314) 989-3695
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
0002642
IL
282N00000X
General Acute Care Hospital
Primary
0002642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003578
HEALTH ALLIANCE
IL
01
—
0182
BLUE CROSS BLUE SHIELD
IL
01
—
105814
HEALTHLINK
IL
01
—
133046300
ACS OWCP
IL
01
—
30045800
BLACK LUNG
IL
01
—
35110
GROUP HEALTH PLAN
IL
Enumeration date
05/23/2005
Last updated
11/27/2023
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