Provider Demographics
NPI:1760426969
Name:SAINT MARY'S HOSPITAL, INC.
Entity Type:Organization
Organization Name:SAINT MARY'S HOSPITAL, INC.
Other - Org Name:ST. MARY'S HOSPITAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REGIONAL DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-4396
Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1221
Mailing Address - Country:US
Mailing Address - Phone:203-709-6000
Mailing Address - Fax:
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1221
Practice Address - Country:US
Practice Address - Phone:203-709-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025060Medicaid
CTH01112OtherOXFORD PROV NO.
CT019OtherANTHEM BLUE CROSS BS
CTIR0800OtherHEALTHNET PROV NO.
CT004041760Medicaid
CT004041760Medicaid
CT019OtherANTHEM BLUE CROSS BS