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NPI Code Detail

MEDICARE: ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN

MEDICARE: ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN
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
1282N00000XGeneral Acute Care Hospital0002659IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1110142202OTHERILRAILROAD MEDICARE ZAFAR
2110237746OTHERILRAILROAD MEDICARE PAL
3IL1789OTHERILMEDICARE GROUP PTAN
4060042510OTHERILRAILROAD MEDICARE PARSONS
5930124689OTHERILRAILROAD MEDICARE
6P00034602OTHERILRAILROAD MEDICARE
8P00034601OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
73573OTHERILHEALTH ALLIANCE ID
90127OTHERILBLUECROSS
10130590000OTHERILUS DEPT OF LABOR
115015121OTHERILBLUESHIELD
12A6136401OTHERILUNITED HEALTHCARE RIVER

General Provider Information

NPI Number : 1295732725
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN
Provider Business Mailing Address
First Line : 111 SPRING ST
Second Line :
City : STREATOR
State : IL
Zip : 61364-3332
Country : US
Telephone Number : 815-673-2311
Fax Number : 815-673-4524
Provider Business Practice Location Address
First Line : 111 SPRING ST
Second Line :
City : STREATOR
State : IL
Zip : 61364-3332
Country : US
Telephone Number : 815-673-2311
Fax Number : 815-673-4524
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : KAREN S CLARK
Credential :
Telephone Number : 815-673-2311
Provider Enumeration Date : 06/30/2005
Last Update Date : 06/13/2012

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Directions to “ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN ” Practice Location

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