Provider Demographics
NPI:1326027855
Name:ST. ELIZABETHS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS
Entity Type:Organization
Organization Name:ST. ELIZABETHS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS
Other - Org Name:ST ELIZABETHS HOSPITAL
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: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:618-234-2120
Mailing Address - Fax:618-222-4628
Practice Address - Street 1:211 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1915
Practice Address - Country:US
Practice Address - Phone:618-234-2120
Practice Address - Fax:618-222-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
0064066OtherBLUE CHOICE
MO010779908Medicaid
IL0248OtherBLUE CROSS
4489OtherGHP
MO0914OtherBLUE CROSS
107847OtherHEALTHLINK
6701313OtherUHC METRAHEALTH
MO010779908Medicaid
IL=========001Medicaid
=========OtherILLINOIS
MO010779908Medicaid