1134122005 NPI number — ST. MARY'S HEALTH INC

Table of content: (NPI 1134122005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134122005 NPI number — ST. MARY'S HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY'S HEALTH INC
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:
ST. VINCENT EVANSVILLE URGENT CARE-EPWORTH
Provider Other Organization Name Type Code:
3
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:
1134122005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 WASHINGTON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-485-6940
Provider Business Mailing Address Fax Number:
812-485-6949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ST. MARY'S EPWORTH CROSSING
Provider Second Line Business Practice Location Address:
SUITE B100
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47630-9161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-853-9651
Provider Business Practice Location Address Fax Number:
812-853-9899
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRIGGELER
Authorized Official First Name:
LOIS
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CREDENTIALING REPRESENTATIVE
Authorized Official Telephone Number:
812-485-6946

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200394440A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".