MEDICARE: ST. MARY'S HEALTH 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
1	261QU0200X	Urgent Care Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336142397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY'S HEALTH INC

Provider Business Mailing Address
First Line	:	3700 WASHINGTON
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47750
Country	:	US
Telephone Number	:	812-485-6940
Fax Number	:	812-485-6949

Provider Business Practice Location Address
First Line	:	100 S ROSENBERGER AVENUE
Second Line	:	SUITE A200
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-6591
Country	:	US
Telephone Number	:	812-485-1550
Fax Number	:	812-485-1560

Authorized Official
Title or Position	:	CREDENTIALING REPRESENTATIVE
Name	:	MRS. LOIS ANN BRIGGELER
Credential	:
Telephone Number	:	812-485-6946

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/27/2017

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Practice Location Address:

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1144223041 — DR. JANE KOCH DPM
Practice Location Address:

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Practice Location Address:

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Directions to “ST. MARY'S HEALTH INC ” Practice Location

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