1205818481 NPI number — ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F

Table of content: (NPI 1205818481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205818481 NPI number — ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F
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:
6
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:
1205818481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
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:
217-544-6464
Provider Business Mailing Address Fax Number:
217-535-3989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 EAST CARPENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62769-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-544-6464
Provider Business Practice Location Address Fax Number:
217-535-3989
Provider Enumeration Date:
11/15/2005

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 REVENUE CYCLE
Authorized Official Telephone Number:
217-492-9651

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0002451 , 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: 115980 . This is a "HEALTHLINK PROVIDER NUMBE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 174 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 000836 . This is a "HEALTH ALLIANCE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 104855 . This is a "HEALTH ALLIANCE ATHELICAR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6251365 . This is a "AETNA INSURANCE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 43889 . This is a "PERSONAL CARE PROVIDER NO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 113377800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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