Provider Demographics
NPI:1336142397
Name:ST. MARY'S HEALTH INC
Entity Type:Organization
Organization Name:ST. MARY'S HEALTH INC
Other - Org Name:ST. VINCENT EVANSVILLE URGENT CARE-WESTSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRIGGELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-485-6946
Mailing Address - Street 1:3700 WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47750
Mailing Address - Country:US
Mailing Address - Phone:812-485-6940
Mailing Address - Fax:812-485-6949
Practice Address - Street 1:100 S ROSENBERGER AVENUE
Practice Address - Street 2:SUITE A200
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6591
Practice Address - Country:US
Practice Address - Phone:812-485-1550
Practice Address - Fax:812-485-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
IN261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200394790AMedicaid
IN200394790AMedicaid