MEDICARE: ST. MARY MEDICAL CENTER

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	207R00000X	Internal Medicine Physician

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	:	1700921541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	164 BRACKEN PKWY
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-6789
Country	:	US
Telephone Number	:	219-947-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	2241 45TH ST
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2601
Country	:	US
Telephone Number	:	219-738-1736
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARY F SUDICKY
Credential	:
Telephone Number	:	219-942-0551

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/11/2024

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Directions to “ST. MARY MEDICAL CENTER ” Practice Location

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