Provider Demographics
NPI:1285634303
Name:ST. MARY'S AT HOME INC
Entity Type:Organization
Organization Name:ST. MARY'S AT HOME INC
Other - Org Name:ST. MARY'S MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:812-485-4600
Mailing Address - Street 1:6840 LOGAN DR
Mailing Address - Street 2:STE E
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8253
Mailing Address - Country:US
Mailing Address - Phone:812-485-4600
Mailing Address - Fax:812-485-6513
Practice Address - Street 1:6840 LOGAN DR
Practice Address - Street 2:STE E
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8253
Practice Address - Country:US
Practice Address - Phone:812-485-4600
Practice Address - Fax:812-485-6513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050070351332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100247940AMedicaid
IN4227030001Medicare NSC