Provider Demographics
NPI:1487656054
Name:ST. MARY'S MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. MARY'S MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-943-2819
Mailing Address - Street 1:201 NW R D MIZE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2518
Mailing Address - Country:US
Mailing Address - Phone:816-943-2819
Mailing Address - Fax:816-943-2237
Practice Address - Street 1:201 NW R D MIZE RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2518
Practice Address - Country:US
Practice Address - Phone:816-943-2819
Practice Address - Fax:816-943-2544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARONDELET HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO403-11282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO260193Medicare Oscar/Certification