Healthcare Provider Details

I. General information

NPI: 1598839730
Provider Name (Legal Business Name): ST. MARY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 80TH PLACE STE 100
MERRILLVILLE IN
46410-5671
US

IV. Provider business mailing address

9660 WICKER AVENUE
ST JOHN IN
46373-9487
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-7536
  • Fax: 219-736-1506
Mailing address:
  • Phone: 219-226-2203
  • Fax: 219-226-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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