Organization
ST. MARYS HOSPITAL
Active
Organization
ST. MARYS HOSPITAL
Active
Parent organization
ST. MARY'S HOSPITAL
Other names
St. Mary's Prairie Cardiology
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
104 W 6TH ST, STREATOR, IL 61364-2899
(815) 672-8741
Mailing address
104 W 6TH ST, STREATOR, IL 61364-2899
(815) 672-8741
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
36114675
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669451233
MD NPI
—
05
—
220782977
—
IL
01
—
5032110
BLUE CROSS
IL
Enumeration date
01/11/2008
Last updated
12/10/2008
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