Provider Demographics
NPI:1205828803
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 AVE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-2204
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:2005-08-19
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-005111-2282NC0060X
IN282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
032184200OtherFEDERAL BLACK LUNG
I013944OtherCHAMPUS
000000054341OtherANTHEM BLUE CROSS
IN100270700Medicaid
I013944OtherCHAMPUS
151325Medicare Oscar/Certification