Provider Demographics
NPI:1093338840
Name:ST MARY'S HOSPITAL AND MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST MARY'S HOSPITAL AND MEDICAL CENTER, INC
Other - Org Name:ST. MARY'S FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-298-2020
Mailing Address - Street 1:2698 PATTERSON RD UNIT 42
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8818
Mailing Address - Country:US
Mailing Address - Phone:970-298-2800
Mailing Address - Fax:970-298-6902
Practice Address - Street 1:2698 PATTERSON RD UNIT 42
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8818
Practice Address - Country:US
Practice Address - Phone:970-298-2800
Practice Address - Fax:970-298-6902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty