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General NPI Number Information
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NPI Number | 1992237051
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Entity Type | Organization
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Legal Business Name | HOSPITAL SISTERS HEALTH SYSTEM
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 3215 EXECUTIVE PARK DR
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City | SPRINGFIELD
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State | IL
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Zip | 62703-4514
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Country | US
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Telephone | 217-757-3164
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Fax |
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Provider Business Mailing Address
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Address Line | 3215 EXECUTIVE PARK DR
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City | SPRINGFIELD
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State | IL
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Zip | 62703-4514
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Country | US
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Telephone | 217-757-3164
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Fax |
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Authorized Official
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Title or Position | HSHS CHIEF PHYSICIAN EXECUTIVE
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Name | DAVID CARLSON
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Credential | DO
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Telephone | 217-492-9169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 26-3956318
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License Number State | IL
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