MEDICARE: ST. MARY'S HEALTH, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	65000006A	IN

General Provider Information

NPI Number	:	1033135660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY'S HEALTH, INC

Provider Business Mailing Address
First Line	:	3900 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0550
Country	:	US
Telephone Number	:	812-485-5804
Fax Number	:	812-485-5810

Provider Business Practice Location Address
First Line	:	3900 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0550
Country	:	US
Telephone Number	:	812-485-5804
Fax Number	:	812-485-5810

Authorized Official
Title or Position	:	INTERIM PRESIDENT
Name	:	MR. DANIEL PAROD
Credential	:
Telephone Number	:	812-485-1502

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	06/27/2024

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