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ST. MARY'S HOSPITAL CENTRALIA ILLINOIS NPI 1770687196


NPI Information

NPI: 1770687196
Provider Name: ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS

Doing Business As: SSM HEALTH ST. MARY'S HOSPITAL - CENTRALIA

Classification: Emergency Medicine - 207P00000X
Entity Type: Organization
Address:
400 N PLEASANT AVE
CENTRALIA, IL
ZIP 62801
Phone: (618) 436-8000
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ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS is an emergency medicine in Centralia, IL. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS NPI is 1770687196. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Ssm Health St. Mary's Hospital - Centralia.

The provider's business location address is:

400 N PLEASANT AVE
CENTRALIA, IL
ZIP 62801-056
Phone: (618) 436-8000

The provider's authorized official is Damon R Harbison .
The authorized official title is President and has the following contact phone number (618) 436-6205.

The enumeration date for this NPI number is 9/8/2006 and was last updated on 11/27/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RI0011XInternal MedicineInterventional Cardiology0002642ILLINOISNo
2208100000XPhysical Medicine & Rehabilitation0002642ILLINOISNo
32084N0400XPsychiatry & NeurologyNeurology0002642ILLINOISNo
42085R0001XRadiologyRadiation Oncology0002642ILLINOISNo
52085R0202XRadiologyDiagnostic Radiology0002642ILLINOISNo
6227800000XRespiratory Therapist, Certified0002642ILLINOISNo
7227900000XRespiratory Therapist, Registered0002642ILLINOISNo
8207P00000XEmergency Medicine0002642ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
135110OTHERILLINOISGROUP HEALTH PLAN
26110182OTHERILLINOISBLUE CROSS BLUE SHIELD
3247625OTHERILLINOISHEALTHLINK NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.