Provider Demographics
NPI:1780686931
Name:ST MARY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST MARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THMA REGIONAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-4704
Mailing Address - Street 1:1201 LANGHORNE-NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1295
Mailing Address - Country:US
Mailing Address - Phone:215-710-2000
Mailing Address - Fax:
Practice Address - Street 1:1201 LANGHORNE-NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1295
Practice Address - Country:US
Practice Address - Phone:215-710-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA710201273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0546204OtherAETNA
PA60048OtherKEYSTONE MERCY HEALTH PLA
PA390258OtherKEYSTONE HEALTH PLAN
PA1007731420004Medicaid
PA0001153000OtherINDEPENDENCE BLUE CROSS
PA60048OtherKEYSTONE MERCY HEALTH PLA
PA1007731420004Medicaid