Healthcare Provider Details

I. General information

NPI: 1669633053
Provider Name (Legal Business Name): ST. MARY'S PHYSICIANS' HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BELLEMEADE AVE SUITE 200-C
EVANSVILLE IN
47714-0100
US

IV. Provider business mailing address

3801 BELLEMEADE AVE SUITE 200-C
EVANSVILLE IN
47714-0100
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-1717
  • Fax:
Mailing address:
  • Phone: 812-485-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN KEIL
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 812-485-1827