NPIMap

Organization Active NPI

St. Mary's Hospital

  • Rural Health Clinic/Center
  • Irvington, IL
National Provider Identifier
1285630624
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0002642 Issued in IL
Legal business name
ST. MARY'S HOSPITAL
Practice address
205 Huron
Irvington, IL 62848
Phone
(618) 249-6203
NPI assigned
Jun 21, 2005
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. MARY'S HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Bruce Merrell
Title
President
Phone
(618) 436-6205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 0002642 IL Primary

Addresses

Primary practice location

205 Huron
Irvington, IL 62848

Mailing address

PO Box 503861
Saint Louis, MO 63150-0001
Phone (618) 249-6203

Other identifiers 2

IdentifierTypeStateIssuer
128375OtherILHEALTHLINK
9515007OtherILBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
SRHC5 organizations share this tax ID, including this one
Part of
SRHC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1285630624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 503861",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631500001",
            "telephone_number": "618-249-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 HURON",
            "city": "IRVINGTON",
            "state": "IL",
            "postal_code": "62848",
            "telephone_number": "618-249-6203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S HOSPITAL",
        "enumeration_date": "2005-06-21",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MERRELL",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-436-6205",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "0002642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "128375",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "9515007",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.