Provider Demographics
NPI:1457308710
Name:ST MARY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST MARY MEDICAL CENTER
Other - Org Name:OSFMG - GALESBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, OSF HEALTHCARE SYSTEM
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-655-2850
Mailing Address - Street 1:124 SW ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1308
Mailing Address - Country:US
Mailing Address - Phone:309-655-2850
Mailing Address - Fax:309-655-4878
Practice Address - Street 1:3375 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1251
Practice Address - Country:US
Practice Address - Phone:800-589-6070
Practice Address - Fax:309-683-5969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSF HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4823452OtherBLUE SHIELD
IL589030Medicare PIN
IL833610Medicare PIN
IL805290Medicare PIN
IL210745Medicare PIN
IL453310Medicare PIN
IL539040Medicare PIN
IL539060Medicare PIN
IL589020Medicare PIN
IL833640Medicare PIN
IL805250Medicare PIN
IL833620Medicare PIN
IL529190Medicare PIN
IL833600Medicare PIN
IL352520Medicare PIN