Provider Demographics
NPI:1659639771
Name:ST. MARY'S CENTER, INC
Entity Type:Organization
Organization Name:ST. MARY'S CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-665-5992
Mailing Address - Street 1:512 W 126TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2406
Mailing Address - Country:US
Mailing Address - Phone:212-665-5992
Mailing Address - Fax:212-665-1855
Practice Address - Street 1:512 W 126TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-2406
Practice Address - Country:US
Practice Address - Phone:212-665-5992
Practice Address - Fax:212-665-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care