1306800602 NPI number — ST. ANTHONY'S MEMORIAL HOSPITAL

Table of content: (NPI 1306800602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306800602 NPI number — ST. ANTHONY'S MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. ANTHONY'S MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. ANTHONY'S MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306800602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3051 HOLLIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62704-7450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-347-1333
Provider Business Mailing Address Fax Number:
217-347-1565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 N MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401-2099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-347-1333
Provider Business Practice Location Address Fax Number:
217-347-1565
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  1630809 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0060089 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 169 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 619698624 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116692 . This is a "HEALTH LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2515006 . This is a "BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 003650 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 379091 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".




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