Provider Demographics
NPI:1922246545
Name:ST MARY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST MARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GARDENHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:219-365-4868
Mailing Address - Street 1:500 HILBRICH DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-4300
Mailing Address - Country:US
Mailing Address - Phone:219-365-4868
Mailing Address - Fax:
Practice Address - Street 1:500 HILBRICH DR
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-4300
Practice Address - Country:US
Practice Address - Phone:219-365-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital