Provider Demographics
NPI:1639498975
Name:ST MARY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ST MARY MEDICAL CENTER INC
Other - Org Name:ST MARY CARE NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SUDICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-924-0551
Mailing Address - Street 1:3545 ARBORS STREET
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4298
Mailing Address - Country:US
Mailing Address - Phone:219-759-6570
Mailing Address - Fax:219-759-6580
Practice Address - Street 1:3545 ARBORS STREET
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4298
Practice Address - Country:US
Practice Address - Phone:219-759-6570
Practice Address - Fax:219-759-6580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty