Provider Demographics
NPI:1801215587
Name:ST MARY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST MARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-2000
Mailing Address - Street 1:4648 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4724
Mailing Address - Country:US
Mailing Address - Phone:215-630-0788
Mailing Address - Fax:
Practice Address - Street 1:1201 NEWTOWN-LANGHORNE ROAD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
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:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013649282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital