Provider Demographics
NPI:1013002658
Name:ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Entity Type:Organization
Organization Name:ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Other - Org Name:CLINTON COUNTY RURAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DUANE
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:618-526-7271
Mailing Address - Fax:618-526-7313
Practice Address - Street 1:9401 HOLY CROSS LANE
Practice Address - Street 2:SUITE 112
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230
Practice Address - Country:US
Practice Address - Phone:618-526-7271
Practice Address - Fax:618-526-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148503Medicare Oscar/Certification
IL143896Medicare Oscar/Certification
ILIL1656Medicare Oscar/Certification