Provider Demographics
NPI:1295732725
Name:ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN
Entity type:Organization
Organization Name:ST. MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-673-2311
Mailing Address - Street 1:111 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-3332
Mailing Address - Country:US
Mailing Address - Phone:815-673-2311
Mailing Address - Fax:815-673-4524
Practice Address - Street 1:111 SPRING ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-3332
Practice Address - Country:US
Practice Address - Phone:815-673-2311
Practice Address - Fax:815-673-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0002659282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110142202OtherRAILROAD MEDICARE ZAFAR
IL110237746OtherRAILROAD MEDICARE PAL
ILIL1789OtherMEDICARE GROUP PTAN
IL060042510OtherRAILROAD MEDICARE PARSONS
IL930124689OtherRAILROAD MEDICARE
ILP00034602OtherRAILROAD MEDICARE
IL3573OtherHEALTH ALLIANCE ID
ILP00034601OtherRAILROAD MEDICARE
IL0127OtherBLUECROSS
IL130590000OtherUS DEPT OF LABOR
IL5015121OtherBLUESHIELD
ILA6136401OtherUNITED HEALTHCARE RIVER
ILIL1789OtherMEDICARE GROUP PTAN
ILP00034601OtherRAILROAD MEDICARE
IL=========401Medicaid
ILP00034601OtherRAILROAD MEDICARE
IL=========OtherFEIN
IL=========001Medicaid
IL=========401Medicaid
IL0127OtherBLUECROSS
ILP00034602OtherRAILROAD MEDICARE
ILIL1789004Medicare PIN