Provider Demographics
NPI:1306800602
Name:ST ANTHONYS MEMORIAL HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD
Entity type:Organization
Organization Name:ST ANTHONYS MEMORIAL HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:EVARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-492-9651
Mailing Address - Street 1:3051 HOLLIS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7450
Mailing Address - Country:US
Mailing Address - Phone:217-347-1333
Mailing Address - Fax:217-347-1565
Practice Address - Street 1:503 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2099
Practice Address - Country:US
Practice Address - Phone:217-347-1333
Practice Address - Fax:217-347-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1630809282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
619698624OtherFIRST HEALTH
003650OtherHEALTH ALLIANCE
379091OtherBLACK LUNG
0060089OtherAETNA
IL169OtherBLUE CROSS
IL2515006OtherBLUE SHIELD
116692OtherHEALTH LINK
379091OtherBLACK LUNG
802360Medicare ID - Type UnspecifiedMEDICARE PART B
IL140032Medicare ID - Type Unspecified
116692OtherHEALTH LINK
IL=========401Medicaid