Healthcare Provider Details

I. General information

NPI: 1447284039
Provider Name (Legal Business Name): ST. MARY'S MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
WEST PALM BEACH FL
33407-2413
US

IV. Provider business mailing address

PO BOX 741191
ATLANTA GA
30374-1191
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-6300
  • Fax:
Mailing address:
  • Phone: 561-982-2189
  • Fax: 561-882-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number4058
License Number StateFL

VIII. Authorized Official

Name: TAREK NASER
Title or Position: CFO
Credential:
Phone: 561-882-6372