Provider Demographics
NPI:1508026402
Name:ST. MARY'S WARRICK HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. MARY'S WARRICK HOSPITAL, INC.
Other - Org Name:ER PHYSICIANS GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-485-1502
Mailing Address - Street 1:1116 MILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-2204
Mailing Address - Country:US
Mailing Address - Phone:812-897-4800
Mailing Address - Fax:812-897-7375
Practice Address - Street 1:1116 MILLIS AVE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-2226
Practice Address - Country:US
Practice Address - Phone:812-897-4800
Practice Address - Fax:812-897-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07-005111-1207P00000X, 282NC0060X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000054351OtherBLUE CROSS BLUE SHIELD
IN032184200OtherFEDERAL BLACK LUNG
KY1341114Medicaid
IN200043160Medicaid
INI013944OtherCHAMPUS
IN941440OtherMEDICARE GROUP