St Marys Hospital

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

002659 Issued in IL

Legal business name

ST MARYS HOSPITAL

Doing business as

St Marys Urology

Practice address

104 W 6TH St
Streator, IL 61364-2899

Phone

(815) 672-7289

Fax

(815) 672-2891

NPI assigned

Jun 22, 2009

Organization subpart

Yes

Parent organization

ST MARYS HOSPITALAs reported in NPPES

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

Authorized official

Name

Angie Houch

Title

Manager, PFS

Phone

(815) 673-4603

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• St Marys Urology Doing business as

Tax ID family

St Mary'S Hospital Streator Hospital Sisters of the 3Rd Order St Fran3 organizations share this tax ID, including this one

Part of

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

Other organizations with this tax ID 2

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

• St. Mary'S Hospital

  • Rural Acute Care Hospital
  • Streator, IL
  • NPI 1750709630
  NPD tax ID
• St. Marys Hospital

  • Cardiovascular Disease Physician
  • Streator, IL
  • NPI 1699951483
  NPD tax ID

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266192000000",
    "number": "1770710360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W 6TH ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642899",
            "telephone_number": "815-672-7289",
            "fax_number": "815-672-2891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W 6TH ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613642899",
            "telephone_number": "815-672-7289",
            "fax_number": "815-672-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARYS HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST MARYS HOSPITAL",
        "enumeration_date": "2009-06-22",
        "last_updated": "2010-02-15",
        "status": "A",
        "authorized_official_last_name": "HOUCH",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "MANAGER, PFS",
        "authorized_official_telephone_number": "815-673-4603"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "IL",
            "license": "002659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN NPI",
            "identifier": "1952392557",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36081908",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD INDIVIDUAL NPI",
            "identifier": "1124085758",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD INDIVIDUAL NPI",
            "identifier": "1851349435",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36113590",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36104105",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Marys Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Calvin Slot, MD
• Bruce Sylvester Smith, M.D.
• Emily K Snow, FNP-C
• John Sorensen, RPH
• 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

• Urology Physician in Streator, IL
• Providers in Streator, IL by specialty
• Urology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2010; 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.