Basic Information
| Provider Information | |||||||||
| NPI: | 1326041229 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST MARYS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | ST MARYS HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 E LAKE SHORE DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625213883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174642966 | ||||||||
| FaxNumber: | 2174641609 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 E LAKE SHORE DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174642966 | ||||||||
| FaxNumber: | 2174641616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KITCHENS | ||||||||
| AuthorizedOfficialFirstName: | SHANE | ||||||||
| AuthorizedOfficialMiddleName: | ANDERSON | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR-BUDGET& FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2174642590 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 282N00000X | 0002592 | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.