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General NPI Number Information
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NPI Number | 1528160736
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Entity Type | Organization
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Legal Business Name | ST MARY MEDICAL CENTER INC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 1437 S LAKE PARK AVE
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City | HOBART
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State | IN
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Zip | 46342
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Country | US
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Telephone | 219-947-6105
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Fax | 219-947-6261
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Provider Business Mailing Address
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Address Line | PO BOX 3604
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City | MUNSTER
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State | IN
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Zip | 46321-0703
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Country | US
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Telephone | 219-836-7370
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Fax | 219-934-8889
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | MRS. CHAR KULLERSTRAND
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Credential |
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Telephone | 219-934-8888
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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 | 060053791
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License Number State | IN
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