1952496176 NPI number — ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952496176 NPI number — ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE
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:
1952496176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2024
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:
618-523-4216
Provider Business Mailing Address Fax Number:
618-523-7049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 MUNSTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-523-4216
Provider Business Practice Location Address Fax Number:
618-523-7049
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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