Healthcare Provider Details

I. General information

NPI: 1487637591
Provider Name (Legal Business Name): ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST CARPENTER
SPRINGFIELD IL
62769-0001
US

IV. Provider business mailing address

3051 HOLLIS DR
SPRINGFIELD IL
62704-7450
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax: 217-535-3989
Mailing address:
  • Phone: 217-544-6464
  • Fax: 217-535-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number0002451
License Number StateIL

VIII. Authorized Official

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