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	293D00000X	Physiological Laboratory

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	:	1558819599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY'S HEALTH, INC

Provider Business Mailing Address
First Line	:	100 S ROSENBERGER AVE
Second Line	:	SUITE A310
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-6591
Country	:	US
Telephone Number	:	812-433-2030
Fax Number	:	812-433-2039

Provider Business Practice Location Address
First Line	:	100 S ROSENBERGER AVE
Second Line	:	SUITE A310
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-6591
Country	:	US
Telephone Number	:	812-433-2030
Fax Number	:	812-433-2039

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL PAROD
Credential	:
Telephone Number	:	812-485-1502

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	08/06/2020

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

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