Healthcare Provider Details

I. General information

NPI: 1952458564
Provider Name (Legal Business Name): ST. MARY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S LAKE PARK AVE
HOBART IN
46342-6638
US

IV. Provider business mailing address

1500 S LAKE PARK AVE
HOBART IN
46342-6638
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6980
  • Fax: 219-947-6037
Mailing address:
  • Phone: 219-947-6980
  • Fax: 219-947-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MARY SUDICKY
Title or Position: CFO
Credential:
Phone: 219-947-6014