Organization
ST. MARY'S HOSPITAL
Active
Parent organization
ST. MARY'S HOSPITAL
Other names
St. Mary's Health Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. MARY'S HOSPITAL
Authorized official
KAREN S CLARK (CFO)
(815) 673-4514
Entity
Organization
Contact information
Practice address
1640 1ST AVE, OTTAWA, IL 61350
(815) 431-9208
Mailing address
1640 1ST AVE, OTTAWA, IL 61350
(815) 431-9208
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0002659
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127
BLUE CROSS
IL
01
—
1760453187
MD NPI
IL
01
—
1942238589
MD NPI
—
01
—
5015121
BLUESHIELD
IL
01
—
IL1789
MEDICARE GROUP
IL
01
—
IL1789004
MEDICARE PTAN
IL
Enumeration date
08/26/2008
Last updated
03/27/2012
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