| Organization Name: | ST. MARY'S HOSPITAL |
| NPI Number: | 1598946543 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KAREN S CLARK (CFO) |
| Mailing Address: | 104 E Bridge St Streator |
| State: | IL US |
| Postal Code: | 613642967 |
| Phone Number: | 8156724015 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2007 |
| NPI Last Update Date: | 05/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | 036078501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |