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1013002658 NPI number — ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE

NPI Number: 1013002658
Health Care Provider/Practitioner: ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE

Information about “1013002658” NPI (ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE) exists in 1013002658 in HTML format HTML  |  1013002658 in plain Text format TXT  |  1013002658 in PDF (Portable Document Format) PDF  |  1013002658 in an XML format XML  formats.

NPI Number : 1013002658 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013002658",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3051 HOLLIS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRINGFIELD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62704-7450",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-526-7271",
    "MailingAddressFaxNumber": "618-526-7313",
    "FirstLinePracticeLocationAddress": "9401 HOLY CROSS LN # 112",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BREESE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62230-3510",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-526-7271",
    "PracticeLocationAddressFaxNumber": "618-526-7313",
    "EnumerationDate": "10/03/2006",
    "LastUpdateDate": "01/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EVARD",
    "AuthorizedOfficialFirstName": "MARK",
    "AuthorizedOfficialMiddleName": "DUANE",
    "AuthorizedOfficialTitle": "VP OF REVENUE CYCLE",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "217-492-9651",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR1300X",
          "TaxonomyName": "Rural Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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