NPIMap

Organization Active NPI

St. Mary'S Hospital

  • Rural Health Clinic/Center
  • Vandalia, IL
National Provider Identifier
1790789451
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
825 New York Dr
Ste 2
Vandalia, IL 62471-1044
Phone
(618) 283-0600
NPI assigned
Jun 10, 2005
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

825 New York Dr
Ste 2
Vandalia, IL 62471-1044

Mailing address

PO Box 503861
Saint Louis, MO 63150-0001
Phone (618) 436-8000

Other identifiers 2

IdentifierTypeStateIssuer
2620625OtherILBLUE CROSS BLUE SHIELD
259114OtherILHEALTHLINK

National Provider Directory

National Provider Directory
Tax ID family
M Wildwood LCSW5 organizations share this tax ID, including this one
Part of
M Wildwood LCSW

Other organizations with this tax ID 4

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

Locations

1050 M L King Dr
Ste 1
Centralia, IL 62801

1054 Martin Luther King Dr
Ste 222
Centralia, IL 62801
Phone (618) 244-3200

31 Long Acre Dr
Fairview Heights, IL 62208

825 New York Dr
Ste 2
Vandalia, IL 62471
Phone (618) 283-0600

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1790789451",
    "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": "618-436-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 NEW YORK DR",
            "address_2": "STE 2",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711044",
            "telephone_number": "618-283-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S HOSPITAL",
        "enumeration_date": "2005-06-10",
        "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": "BLUE CROSS BLUE SHIELD",
            "identifier": "2620625",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "259114",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vandalia, 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.