Basic Information
| Provider Information | |||||||||
| NPI: | 1558463745 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST MARY MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3603 | ||||||||
| Address2: | |||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463210757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199348888 | ||||||||
| FaxNumber: | 2199348889 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 S LAKE PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HOBART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463426638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199420551 | ||||||||
| FaxNumber: | 2199348889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SCHNEIDER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2199348999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 060057861 | IN | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100268660 | 05 | IN | MEDICAID |