Healthcare Provider Details

I. General information

NPI: 1740681261
Provider Name (Legal Business Name): ST. MARY'S HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S 4TH ST
BOONVILLE IN
47601-1809
US

IV. Provider business mailing address

415 S 4TH ST
BOONVILLE IN
47601-1809
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-7078
  • Fax:
Mailing address:
  • Phone: 812-897-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KEITH JEWELL
Title or Position: PRESIDENT
Credential:
Phone: 812-485-4000