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General NPI Number Information
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NPI Number | 1457319154
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Entity Type | Organization
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Legal Business Name | ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 9515 HOLY CROSS LN BOX 99
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City | BREESE
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State | IL
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Zip | 62230-3618
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Country | US
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Telephone | 618-526-4511
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Fax | 618-526-2291
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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 | 618-526-4511
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Fax | 618-526-2291
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Authorized Official
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Title or Position | VP OF REVENUE CYCLE
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Name | MARK DUANE 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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 0002527
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License Number State | IL
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