1598839730 NPI number — ST. MARY MEDICAL CENTER INC

Table of content: (NPI 1598839730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598839730 NPI number — ST. MARY MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY MEDICAL CENTER 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:
MICHAEL KOVACICH MD
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:
1598839730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9660 WICKER AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST JOHN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46373-9487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-226-2203
Provider Business Mailing Address Fax Number:
219-226-2202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E 80TH PLACE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-5671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-769-7536
Provider Business Practice Location Address Fax Number:
219-736-1506
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RYBA
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
219-942-0551

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200251650 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com