Provider Demographics
NPI:1093028201
Name:ST MARY'S MEDICAL CENTER OF EVANSVILLE, INC
Entity Type:Organization
Organization Name:ST MARY'S MEDICAL CENTER OF EVANSVILLE, INC
Other - Org Name:ST MARY'S PODIATRY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT AND CMO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-485-4000
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47705-0717
Mailing Address - Country:US
Mailing Address - Phone:812-471-1591
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:3801 BELLEMEADE AVE
Practice Address - Street 2:STE 110
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0100
Practice Address - Country:US
Practice Address - Phone:812-485-8390
Practice Address - Fax:812-485-4679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARY'S MEDICAL CENTER OF EVANSVILLE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-16
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty