Healthcare Provider Details

I. General information

NPI: 1508026402
Provider Name (Legal Business Name): ST. MARY'S WARRICK HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MILLIS AVE
BOONVILLE IN
47601-2226
US

IV. Provider business mailing address

1116 MILLIS AVE
BOONVILLE IN
47601-2204
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-4800
  • Fax: 812-897-7375
Mailing address:
  • Phone: 812-897-4800
  • Fax: 812-897-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number07-005111-1
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number07-005111-1
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL PAROD
Title or Position: CEO
Credential:
Phone: 812-485-1502