Organization
ST. MARY'S HOSPITAL
Active
Parent organization
ST. MARY'S HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARY'S HOSPITAL
Authorized official
MR. BRUCE MERRELL (PRESIDENT)
(618) 436-6205
Entity
Organization
Contact information
Practice address
205 HURON, IRVINGTON, IL 62848
(618) 249-6203
Mailing address
PO BOX 503861, SAINT LOUIS, MO 63150-0001
(618) 249-6203
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
0002642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128375
HEALTHLINK
IL
01
—
9515007
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/21/2005
Last updated
04/20/2008
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