St. Mary'S Hospital

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

036078501 Issued in IL

Legal business name

ST. MARY'S HOSPITAL

Doing business as

St. Mary's Vascular and Thoracic Surgery

Practice address

104 E Bridge St
Streator, IL 61364-2967

Phone

(815) 672-4015

NPI assigned

Nov 19, 2007

Organization subpart

Yes

Parent organization

ST. MARY'S HOSPITALAs reported in NPPES

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

Authorized official

Name

Karen S Clark

Title

Cfo

Phone

(815) 673-4514

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• St. Mary's Vascular and Thoracic Surgery Doing business as

Part of

St Mary'S Hospital Streator Hospital Sisters of the 3Rd Order St Fran

Locations

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

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1598946543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E BRIDGE ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642967",
            "telephone_number": "815-672-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E BRIDGE ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642967",
            "telephone_number": "815-672-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S HOSPITAL",
        "enumeration_date": "2007-11-19",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "815-673-4514"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036078501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36121627",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD NPI",
            "identifier": "1548281926",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "IL1789",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD",
            "identifier": "5032121",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Vascular and Thoracic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St Marys Hospital
• St Marys Hospital
• St Marys Hospital Streator Hospital Sisters of the 3Rd Ordr St Francis
• St Marys Hospital Streator Hospital Sisters of the 3Rd Ordr St Francis
• St. Margaret'S Health-Peru
• St. Mary'S Hospital
• St. Mary'S Hospital Streator Hospital Sisters of the 3Rd Order St Fran
• St. Marys Hospital
• Kelly Lynn Stiles, LMT
• Kimberly Stoffle

• Vascular Surgery Physician in Streator, IL
• Providers in Streator, IL by specialty
• Vascular Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; 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.