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NPI Code Detail

MEDICARE: ST. MARY'S WARRICK HOSPITAL, INC.

MEDICARE: ST. MARY'S WARRICK HOSPITAL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282NC0060XCritical Access Hospital05-005111-2IN
2282NC0060XCritical Access HospitalIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1032184200OTHERFEDERAL BLACK LUNG
2I013944OTHERCHAMPUS
3000000054341OTHERANTHEM BLUE CROSS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205828803
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. MARY'S WARRICK HOSPITAL, INC.
Provider Business Mailing Address
First Line : 1116 MILLIS AVE
Second Line :
City : BOONVILLE
State : IN
Zip : 47601-2204
Country : US
Telephone Number : 812-897-4800
Fax Number : 812-897-7375
Provider Business Practice Location Address
First Line : 1116 MILLIS AVE
Second Line :
City : BOONVILLE
State : IN
Zip : 47601-2204
Country : US
Telephone Number : 812-897-4800
Fax Number : 812-897-7375
Authorized Official
Title or Position : ADMINISTRATOR
Name : MARTY P MATTINGLY
Credential :
Telephone Number : 812-897-7112
Provider Enumeration Date : 08/19/2005
Last Update Date : 06/29/2020

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