Healthcare Provider Details

I. General information

NPI: 1548661077
Provider Name (Legal Business Name): ST MARYS HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ST MARYS EPWORTH XING STE A500
NEWBURGH IN
47630-9497
US

IV. Provider business mailing address

100 ST MARYS EPWORTH XING STE A500
NEWBURGH IN
47630-9497
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-4437
  • Fax: 812-485-6890
Mailing address:
  • Phone: 812-485-4437
  • Fax: 812-485-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEITH JEWELL
Title or Position: PRESIDENT
Credential:
Phone: 812-485-4000