Provider Demographics
NPI:1568913101
Name:ST. MARY'S HEALTH, INC
Entity Type:Organization
Organization Name:ST. MARY'S HEALTH, INC
Other - Org Name:ST. VINCENT EVANSVILLE URGENT CARE-NORTHSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-485-4000
Mailing Address - Street 1:14020 OLD STATE RD
Mailing Address - Street 2:SUITE A100
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-1164
Mailing Address - Country:US
Mailing Address - Phone:812-469-4740
Mailing Address - Fax:812-469-4786
Practice Address - Street 1:14020 OLD STATE RD
Practice Address - Street 2:SUITE A100
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-1164
Practice Address - Country:US
Practice Address - Phone:812-469-4740
Practice Address - Fax:812-469-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care