Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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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 is a Physician Assistant 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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