Provider Demographics
NPI:1619950755
Name:ST ELIZABETHS HOSPITAL HOME HEALTH SERVICES OF BELLEVILLE
Entity Type:Organization
Organization Name:ST ELIZABETHS HOSPITAL HOME HEALTH SERVICES OF BELLEVILLE
Other - Org Name:
Other - Org Type:
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:618-277-9360
Mailing Address - Fax:618-222-4680
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:618-277-9360
Practice Address - Fax:618-222-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1005180251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
003673OtherHEALTH ALLIANCE
IL280445OtherHARMONY HEALTH PLAN
60 00092OtherUNITED HEALTHCARE
60 00090OtherUNITED HEALTHCARE
437673OtherHEALTHLINK
51649OtherGROUP HEALTH PLAN
MO209OtherBLUE CROSS BLUE SHIELD
IL9889OtherBLUE CROSS BLUE SHIELD
7116430OtherAETNA
IL========= 003Medicaid
003673OtherHEALTH ALLIANCE
437673OtherHEALTHLINK
7116430OtherAETNA
437673OtherHEALTHLINK