Provider Demographics
NPI:1558638825
Name:ST MARYS AT HOME INC
Entity Type:Organization
Organization Name:ST MARYS 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:
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:812-485-4000
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1223
Mailing Address - Country:US
Mailing Address - Phone:812-485-4600
Mailing Address - Fax:812-485-6513
Practice Address - Street 1:2345 W FRANKLIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-5100
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:2011-11-30
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4227030001Medicare NSC