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General NPI Number Information
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NPI Number | 1194736728
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Entity Type | Organization
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Legal Business Name | ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 211 S 3RD ST
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City | BELLEVILLE
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State | IL
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Zip | 62220-1915
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Country | US
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Telephone | 618-234-2120
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Fax | 618-222-4761
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Provider Business Mailing Address
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Address Line | 3051 HOLLIS DR
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7450
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Country | US
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Telephone | 618-234-2120
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Fax | 618-222-4761
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Authorized Official
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Title or Position | VP OF REVENUE CYCLE
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Name | MARK D EVARD
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Credential |
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Telephone | 217-492-9651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 041.334033
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0002345
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 0002345
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License Number State | IL
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