MEDICARE: ST MARYS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140166	OTHER	IL	MEDICARE

General Provider Information

NPI Number	:	1285126631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MARYS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Provider Business Mailing Address
First Line	:	3051 HOLLIS DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-7450
Country	:	US
Telephone Number	:	217-464-2590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 E LAKE SHORE DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-3883
Country	:	US
Telephone Number	:	217-464-2590
Fax Number	:

Authorized Official
Title or Position	:	VP OF REVENUE CYCLE
Name	:	MARK D EVARD
Credential	:
Telephone Number	:	217-492-9651

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	09/19/2023

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