Provider Demographics
NPI:1073668273
Name:ST. MARY'S WARRICK HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MARY'S WARRICK HOSPITAL, INC.
Other - Org Name:ASCENSION ST. VINCENT WARRICK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MATTINGLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-897-7112
Mailing Address - Street 1:1116 MILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-2204
Mailing Address - Country:US
Mailing Address - Phone:812-897-4800
Mailing Address - Fax:812-897-7375
Practice Address - Street 1:1116 MILLIS AVENUE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601
Practice Address - Country:US
Practice Address - Phone:812-897-4800
Practice Address - Fax:812-897-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1341114Medicaid
032184200OtherFEDERAL BLACK LUNG
IN100270700Medicaid
I013944OtherCHAMPUS
IN000000054341OtherANTHEM BLUE CROSS
032184200OtherFEDERAL BLACK LUNG
KY1341114Medicaid