Provider Demographics
NPI:1952333205
Name:ST. MARY'S MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST. MARY'S MEDICAL CENTER, INC
Other - Org Name:ST. MARY'S MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:NASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-882-6372
Mailing Address - Street 1:PO BOX 741191
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1191
Mailing Address - Country:US
Mailing Address - Phone:561-982-2189
Mailing Address - Fax:561-882-4562
Practice Address - Street 1:901 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2413
Practice Address - Country:US
Practice Address - Phone:561-844-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4058282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010148600Medicaid
100288B000000OtherSECTION 1011
75-2932987OtherPREFERRED HLTH PROVS
75-2932992OtherPRO AMERICA
277028OtherAVMED
75-2932994OtherPROGRESSIVE AMERICAN INSU
75-2932996OtherPROTECTIVE LIFE
75-2932999OtherRISK MGMT RESOURCES
080099OtherHUMANA
75-2932993OtherPROFESSIONAL BENEFIT SERV
75-2933002OtherSAFECO
754204800OtherAETNA US HEALTHCARE
75-2932998OtherPYRAMID BENEFITS
75-2932834OtherAMERIGROUP FLORIDA
75-2932990OtherPRISON HEALTH SERVICE
990348OtherNEIGHBORHOOD HEALTH PLAN
75-2932985OtherPOMCO
75-2933001OtherROYAL & SUNALLIANCE
75-2932993OtherPROFESSIONAL BENEFIT SERV