Organization
ST MARYS HOSPITAL
Active
Parent organization
ST MARYS HOSPITAL
Other names
St Marys Urology
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST MARYS HOSPITAL
Authorized official
ANGIE HOUCH (MANAGER, PFS)
(815) 673-4603
Entity
Organization
Contact information
Practice address
104 W 6TH ST, STREATOR, IL 61364-2899
(815) 672-7289
(815) 672-2891
Mailing address
104 W 6TH ST, STREATOR, IL 61364-2899
(815) 672-7289
(815) 672-2891
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
002659
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124085758
MD INDIVIDUAL NPI
—
01
—
1851349435
MD INDIVIDUAL NPI
—
01
—
1952392557
PHYSICIAN NPI
IL
05
—
36081908
—
IL
05
—
36104105
—
IL
05
—
36113590
—
IL
Enumeration date
06/22/2009
Last updated
02/15/2010
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