Organization
ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Active
Other names
The Sports & Physical Medicine Clinic @ 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
1900 E LAKE SHORE DR, SUITE 200, DECATUR, IL 62521-3824
(217) 464-1030
(217) 464-1039
Mailing address
3051 HOLLIS DR, SPRINGFIELD, IL 62704-7450
(217) 464-2966
(217) 464-1039
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-003034
IL
Other
Enumeration date
10/31/2007
Last updated
10/31/2024
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