Healthcare Provider Details

I. General information

NPI: 1023097540
Provider Name (Legal Business Name): ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT ELIZABETH BLVD
O FALLON IL
62269-1099
US

IV. Provider business mailing address

3051 HOLLIS DR
SPRINGFIELD IL
62704-7450
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-2120
  • Fax: 618-641-5486
Mailing address:
  • Phone: 618-234-2120
  • Fax: 618-222-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateIL

VIII. Authorized Official

Name: MARK D EVARD
Title or Position: VP OF REVENUE CYCLE
Credential:
Phone: 217-492-9651