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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1922553627
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	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-6591
Country	:	US
Telephone Number	:	812-485-8740
Fax Number	:	812-485-8741

Provider Business Practice Location Address
First Line	:	100 S ROSENBERGER AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-6591
Country	:	US
Telephone Number	:	812-485-8740
Fax Number	:	812-485-8741

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH JEWELL
Credential	:
Telephone Number	:	812-485-4000

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	06/29/2020

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