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 CFO (PRESIDENT)
(618) 436-6205
Entity
Organization
Contact information
Practice address
400 N PLEASANT AVE, CENTRALIA, IL 62801-3056
(618) 436-8000
Mailing address
1145 CORPORATE LAKE DR, SAINT LOUIS, MO 63132-2907
(314) 989-2492
(314) 344-7281
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0002642
IL
207RI0011X
Interventional Cardiology Physician
0002642
IL
208100000X
Physical Medicine & Rehabilitation Physician
0002642
IL
2084N0400X
Neurology Physician
0002642
IL
2085R0001X
Radiation Oncology Physician
0002642
IL
2085R0202X
Diagnostic Radiology Physician
0002642
IL
227800000X
Certified Respiratory Therapist
0002642
IL
227900000X
Registered Respiratory Therapist
0002642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247625
HEALTHLINK NUMBER
IL
01
—
35110
GROUP HEALTH PLAN
IL
01
—
6110182
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/08/2006
Last updated
11/27/2023
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