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General NPI Number Information
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NPI Number | 1427201110
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Entity Type | Organization
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Legal Business Name | ST MARYS AT HOME, INC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 3700 WASHINGTON AVE
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City | EVANSVILLE
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State | IN
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Zip | 47750-0001
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Country | US
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Telephone | 812-485-4600
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Fax | 812-485-6513
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Provider Business Mailing Address
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Address Line | 3700 WASHINGTON AVE
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City | EVANSVILLE
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State | IN
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Zip | 47750-0001
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Country | US
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Telephone | 812-485-4600
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Fax | 812-485-6513
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Authorized Official
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Title or Position | MANAGER
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Name | CHRIS BROSMER
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Credential |
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Telephone | 812-485-7228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 69000397A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 69000397A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 69000397A
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License Number State | IN
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