Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

St Marys Hospital Decatur of the Hospital Sisters of the Third Order

Organization Physician Assistant · NPI 1174702708

St Marys Hospital Decatur of the Hospital Sisters of the Third Order provides Physician Assistant services in Decatur, Illinois. Licensed in Illinois. Registered with an NPI since 2007.

Licensed in
IL
In the registry since
2007
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Practice location Address checks out

1900 E Lake Shore Dr Ste 200
Decatur, IL 62521-3824
Phone: (217) 464-1030
Fax: (217) 464-1039
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085-003034 (IL)

Record details

NPI number1174702708
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mark Evard — Vp Of Revenue Cycle · (217) 492-9651
Other names The Sports & Physical Medicine Clinic @ St. Mary'S; The Sports & Physical Medicine Clinic @ St. Mary'S
NPI enumeratedOctober 31, 2007
Last updated in NPPESOctober 31, 2024
Certification dateOctober 31, 2024
Mailing address3051 Hollis Dr, Springfield, IL 62704-7450

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