1952333205 NPI number — ST. MARY'S MEDICAL CENTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952333205 NPI number — ST. MARY'S MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY'S 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:
Provider Other Organization Name Type Code:
6
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:
1952333205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741191
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-1191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-982-2189
Provider Business Mailing Address Fax Number:
561-882-4562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 45TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-844-6300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAGANO
Authorized Official First Name:
ANGELO
Authorized Official Middle Name:
Authorized Official Title or Position:
VP & AO
Authorized Official Telephone Number:
469-893-2327

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  4058 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010148600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100288B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932987 . This is a "PREFERRED HLTH PROVS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932992 . This is a "PRO AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 277028 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932994 . This is a "PROGRESSIVE AMERICAN INSU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932996 . This is a "PROTECTIVE LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932999 . This is a "RISK MGMT RESOURCES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080099 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932993 . This is a "PROFESSIONAL BENEFIT SERV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2933002 . This is a "SAFECO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 754204800 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932998 . This is a "PYRAMID BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932834 . This is a "AMERIGROUP FLORIDA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932990 . This is a "PRISON HEALTH SERVICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 990348 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2932985 . This is a "POMCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-2933001 . This is a "ROYAL & SUNALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010148600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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