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General NPI Number Information
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NPI Number | 1144507708
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Entity Type | Organization
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Legal Business Name | ST. MARY'S MEDICAL CENTER
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 1001 KENWOOD AVENUE
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City | DULUTH
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State | MN
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Zip | 55811-2370
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Country | US
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Telephone | 218-723-6564
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Fax | 218-723-6548
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Provider Business Mailing Address
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Address Line | 1001 KENWOOD AVENUE
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City | DULUTH
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State | MN
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Zip | 55811-2370
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Country | US
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Telephone | 218-723-6564
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Fax | 218-723-6548
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Authorized Official
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Title or Position | EVP HOSPITAL OPERATIONS
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Name | JAMES GARVEY
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Credential |
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Telephone | 218-786-4878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 355203
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License Number State | MN
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