Provider Demographics
NPI:1235661539
Name:ST MARYS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST MARYS MEDICAL CENTER
Other - Org Name:ESSENTIA HEALTH ST MARYS MEDICAL CENTER (ORTHO BUNDLE)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP HOSPITAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-4878
Mailing Address - Street 1:407 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1950
Mailing Address - Country:US
Mailing Address - Phone:218-786-4000
Mailing Address - Fax:
Practice Address - Street 1:407 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1950
Practice Address - Country:US
Practice Address - Phone:218-786-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARYS DULUTH CLINIC HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN380513282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital