MEDICARE: ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital
2	282N00000X	General Acute Care Hospital	0002592	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326041229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER

Provider Business Mailing Address
First Line	:	3051 HOLLIS DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-7450
Country	:	US
Telephone Number	:	217-464-2966
Fax Number	:	217-464-1609

Provider Business Practice Location Address
First Line	:	1800 E LAKE SHORE DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521
Country	:	US
Telephone Number	:	217-464-2966
Fax Number	:	217-464-1616

Authorized Official
Title or Position	:	SYSTEM DIRECTOR-GOVERNMENT REIMB
Name	:	ANN BOND
Credential	:
Telephone Number	:	217-814-4586

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/21/2026

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