St Marys Hospital Decatur of the Hospital Sisters of the Third Order

NPI #1174702708 in Decatur, Illinois

Provider Information

NPI Number: 1174702708
Entity Type: Organization
Organization Name: St Marys Hospital Decatur of the Hospital Sisters of the Third Order
Primary Specialty: Physician Assistant
Enumeration Date: Oct 31, 2007
Last Updated: Oct 31, 2024

Practice Location

Address: 1900 E LAKE SHORE DR
Address 2: SUITE 200
City: Decatur
State: Illinois
ZIP Code: 62521-3824
Phone: (217) 464-1030

Authorized Official

Name: MARK D EVARD
Title: VP OF REVENUE CYCLE
Phone: (217) 492-9651

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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