1295732725 NPI number — ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN

Table of content: EDNA CARTER HICKSON (NPI 1952042590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295732725 NPI number — ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN
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:
Provider Other Organization Name Type Code:
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:
1295732725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STREATOR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61364-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-673-2311
Provider Business Mailing Address Fax Number:
815-673-4524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STREATOR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61364-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-673-2311
Provider Business Practice Location Address Fax Number:
815-673-4524
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
815-673-2311

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0002659 , 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: 110142202 . This is a "RAILROAD MEDICARE ZAFAR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 110237746 . This is a "RAILROAD MEDICARE PAL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: IL1789 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 060042510 . This is a "RAILROAD MEDICARE PARSONS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 930124689 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00034602 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3573 . This is a "HEALTH ALLIANCE ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00034601 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0127 . This is a "BLUECROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 130590000 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5015121 . This is a "BLUESHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: A6136401 . This is a "UNITED HEALTHCARE RIVER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com