Provider Demographics
NPI:1205818481
Name:ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F
Entity type:Organization
Organization Name:ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP 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:217-544-6464
Mailing Address - Fax:217-535-3989
Practice Address - Street 1:800 EAST CARPENTER STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:217-535-3989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-15
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002451282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL115980OtherHEALTHLINK PROVIDER NUMBE
IL174OtherBLUE CROSS PROVIDER NUMBE
IL000836OtherHEALTH ALLIANCE NUMBER
IL104855OtherHEALTH ALLIANCE ATHELICAR
IL6251365OtherAETNA INSURANCE NUMBER
IL43889OtherPERSONAL CARE PROVIDER NO
IL174OtherBLUE CROSS PROVIDER NUMBE
IL=========001Medicaid