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General NPI Number Information
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NPI Number | 1083617245
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Entity Type | Organization
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Legal Business Name | ST MARY'S HOSPITAL, CENTRALIA, ILLINOIS
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 400 N PLEASANT AVE
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City | CENTRALIA
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State | IL
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Zip | 62801
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Country | US
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Telephone | 618-436-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 CORPORATE LAKE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1716
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Country | US
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Telephone | 314-989-3524
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Fax | 314-989-3695
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAMON R HARBISON
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Credential |
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Telephone | 618-436-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 0002642
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 0002642
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License Number State | IL
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