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) 436-6205
Entity
Organization
Contact information
Practice address
400 N PLEASANT AVE, CENTRALIA, IL 62801
(618) 436-8000
Mailing address
PO BOX 503861, SAINT LOUIS, MO 63150-0001
(618) 436-8000
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
0002642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6123830
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/12/2006
Last updated
11/27/2023
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