Healthcare Provider Details

I. General information

NPI: 1093028201
Provider Name (Legal Business Name): ST MARY'S MEDICAL CENTER OF EVANSVILLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BELLEMEADE AVE STE 110
EVANSVILLE IN
47714-0100
US

IV. Provider business mailing address

PO BOX 717
EVANSVILLE IN
47705-0717
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-8390
  • Fax: 812-485-4679
Mailing address:
  • Phone: 812-471-1591
  • Fax: 812-471-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOHN T GALLAGHER
Title or Position: SR VICE PRESIDENT AND CMO
Credential: MD
Phone: 812-485-4000