Organization
ST MARYS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS
Active
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
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-2966
Mailing address
3051 HOLLIS DR, SPRINGFIELD, IL 62704-7450
(217) 464-2966
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14S166
MEDICARE PTAN
IL
Enumeration date
03/02/2011
Last updated
09/19/2023
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