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. TIM BULLER CFO (REGIONAL CFO)
(314) 989-2492
Entity
Organization
Contact information
Practice address
400 N PLEASANT AVE, CENTRALIA, IL 62801-3056
(618) 436-6056
(618) 532-9365
Mailing address
1145 CORPORATE LAKE DR, SAINT LOUIS, MO 63132-2907
(314) 989-2492
(314) 344-7281
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0002642
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
0002642
IL
Other
Enumeration date
12/05/2016
Last updated
03/26/2018
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