Provider Demographics
NPI:1033135660
Name:ST. MARY'S HEALTH, INC
Entity Type:Organization
Organization Name:ST. MARY'S HEALTH, INC
Other - Org Name:ST. VINCENT EVANSVILLE MOBILE DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-485-1502
Mailing Address - Street 1:3700 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-485-5804
Mailing Address - Fax:812-485-5810
Practice Address - Street 1:3700 BELLEMEADE AVENUE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714
Practice Address - Country:US
Practice Address - Phone:812-485-5804
Practice Address - Fax:812-485-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN65000006A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty