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1043486731 NPI number — ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER

NPI Number: 1043486731
Health Care Provider/Practitioner: ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER

Information about “1043486731” NPI (ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER) exists in 1043486731 in HTML format HTML  |  1043486731 in plain Text format TXT  |  1043486731 in PDF (Portable Document Format) PDF  |  1043486731 in an XML format XML  formats.

NPI Number : 1043486731 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043486731",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER",
    "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": "217-464-2505",
    "MailingAddressFaxNumber": "217-464-1669",
    "FirstLinePracticeLocationAddress": "1770 E LAKE SHORE DR",
    "SecondLinePracticeLocationAddress": "SUITE 202",
    "PracticeLocationAddressCityName": "DECATUR",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62521-3832",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-464-2505",
    "PracticeLocationAddressFaxNumber": "217-464-1669",
    "EnumerationDate": "05/02/2008",
    "LastUpdateDate": "10/31/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EVARD",
    "AuthorizedOfficialFirstName": "MARK",
    "AuthorizedOfficialMiddleName": "D",
    "AuthorizedOfficialTitle": "VP OF REVENUE CYCLE",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "217-492-9651",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208800000X",
        "TaxonomyName": "Urology Physician",
        "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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