Provider Demographics
NPI:1912171653
Name:HSHS HOLY FAMILY HOSPITAL INC.
Entity Type:Organization
Organization Name:HSHS HOLY FAMILY HOSPITAL INC.
Other - Org Name:HSHS HOLY FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DUANE
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:618-669-2270
Mailing Address - Fax:618-669-7275
Practice Address - Street 1:507 W STATE ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IL
Practice Address - Zip Code:62275-3017
Practice Address - Country:US
Practice Address - Phone:618-664-1380
Practice Address - Fax:618-664-4239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005355261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-8520OtherMEDICARE PROVIDER NUMBER