Healthcare Provider Details

I. General information

NPI: 1306170477
Provider Name (Legal Business Name): ST MARY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10607 RANDOLPH ST STE C
CROWN POINT IN
46307-7505
US

IV. Provider business mailing address

9660 WICKER AVE
ST JOHN IN
46373-9487
US

V. Phone/Fax

Practice location:
  • Phone: 219-663-1841
  • Fax: 219-663-1846
Mailing address:
  • Phone: 219-226-2203
  • Fax: 219-226-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANICE RYBA
Title or Position: CEO
Credential:
Phone: 219-942-0551