Provider Demographics
NPI:1366844334
Name:ST. MARY'S HEALTH, INC.
Entity Type:Organization
Organization Name:ST. MARY'S HEALTH, INC.
Other - Org Name:ST. VINCENT EVANSVILLE URGENT CARE -BOONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-485-7930
Mailing Address - Street 1:3700 WASHINGTON AVE
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 1:3277 LIBERTY BLVD
Practice Address - Street 2:STE A
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-9659
Practice Address - Country:US
Practice Address - Phone:812-897-8500
Practice Address - Fax:812-897-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200394440BMedicaid
IN200394440BMedicaid