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General NPI Number Information
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NPI Number | 1689821134
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Entity Type | Organization
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Legal Business Name | ST. MARY'S HOSPITAL
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 1640 1ST AVE
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City | OTTAWA
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State | IL
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Zip | 61350
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Country | US
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Telephone | 815-431-9208
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 1ST AVE
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City | OTTAWA
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State | IL
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Zip | 61350
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Country | US
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Telephone | 815-431-9208
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KAREN S CLARK
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Credential |
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Telephone | 815-673-4514
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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 | 0002659
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License Number State | IL
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