NPIMap

Organization Active NPI

St Elizabeths Hospital of the Hospital Sisters of the Third Order

Doing business as St Elizabeths Hospital Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Belleville, IL
National Provider Identifier
1366507485
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054017328 051040885 Issued in IL
Legal business name
ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Doing business as
St Elizabeths Hospital Outpatient Pharmacy
Practice address
211 S 3Rd St
Belleville, IL 62220-1915
Phone
(618) 234-2120
Fax
(618) 222-4786
NPI assigned
Dec 27, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Mark D Evard
Title
VP of Revenue Cycle
Phone
(217) 492-9651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054017328 051040885 IL Primary

Addresses

Primary practice location

211 S 3Rd St
Belleville, IL 62220-1915

Mailing address

3051 Hollis Dr
Springfield, IL 62704-7450
Phone (618) 234-2120

Other identifiers 1

IdentifierTypeStateIssuer
1470676OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • ST ELIZABETHS HOSPITAL OUTPATIENT PHARMACY Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hshs_st_elizabeth_ofallon2202617@ewd.direct.hshs.org Direct

National Provider Directory

National Provider Directory
Tax ID family
St Eliz Hosp8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1366507485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 HOLLIS DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627047450",
            "telephone_number": "618-234-2120",
            "fax_number": "618-222-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S 3RD ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201915",
            "telephone_number": "618-234-2120",
            "fax_number": "618-222-4786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "EVARD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE",
        "authorized_official_telephone_number": "217-492-9651"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054017328 051040885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1470676",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hshs_st_elizabeth_ofallon2202617@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1 Saint Elizabeth Blvd",
            "city": "O Fallon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622691099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ST ELIZABETHS HOSPITAL OUTPATIENT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ST ELIZABETHS HOSPITAL OUTPATIENT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.