Provider Demographics
NPI:1407067978
Name:SAINT ELIZABETH'S HOSPITAL
Entity Type:Organization
Organization Name:SAINT ELIZABETH'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:BOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:618-234-2120
Mailing Address - Street 1:772 GLEN MOR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-3482
Mailing Address - Country:US
Mailing Address - Phone:318-277-1951
Mailing Address - Fax:618-277-3738
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital