1437382876 NPI number — ST MARY MEDICAL CENTER

Table of content: (NPI 1437382876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437382876 NPI number — ST MARY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST MARY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JONATHAN G. PATTERSON D.O.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437382876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10607 RANDOLPH ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CROWN POINT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46307-7504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-663-4007
Provider Business Mailing Address Fax Number:
219-663-4198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10607 RANDOLPH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CROWN POINT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46307-7504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-663-4007
Provider Business Practice Location Address Fax Number:
219-663-4198
Provider Enumeration Date:
09/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SUDICKY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
219-942-0551

Provider Taxonomy Codes

  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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