Provider Demographics
NPI:1851306690
Name:ST MARY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ST MARY MEDICAL CENTER INC
Other - Org Name:-
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:219-942-0551
Mailing Address - Street 1:164 BRACKEN PKWY
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6789
Mailing Address - Country:US
Mailing Address - Phone:219-947-6780
Mailing Address - Fax:219-947-6778
Practice Address - Street 1:209 E 86TH CT
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6529
Practice Address - Country:US
Practice Address - Phone:219-736-9042
Practice Address - Fax:219-942-9247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200251650IMedicaid
IN200251650IMedicaid