MEDICARE: ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER

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	273R00000X	Psychiatric Hospital Unit		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0914	OTHER	MO	BLUE CROSS
2	4489	OTHER		GHP
3	107847	OTHER		HEALTHLINK
4	0064066	OTHER		BLUE CHOICE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0248	OTHER	IL	BLUE CROSS
7	6701313	OTHER		UHC METRAHEALTH

General Provider Information

NPI Number	:	1326027855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER

Provider Business Mailing Address
First Line	:	3051 HOLLIS DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-7450
Country	:	US
Telephone Number	:	618-234-2120
Fax Number	:	618-222-4628

Provider Business Practice Location Address
First Line	:	211 S 3RD ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-1915
Country	:	US
Telephone Number	:	618-234-2120
Fax Number	:	618-222-4628

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	10/31/2024

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Directions to “ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER ” Practice Location

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