Provider Demographics
NPI:1962472548
Name:ST MARYS MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST MARYS MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-526-1224
Mailing Address - Street 1:2900 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702
Mailing Address - Country:US
Mailing Address - Phone:304-526-1014
Mailing Address - Fax:304-526-1021
Practice Address - Street 1:2900 FIRST AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702
Practice Address - Country:US
Practice Address - Phone:304-526-1014
Practice Address - Fax:304-526-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001287001Medicaid
WV0001287002OtherUNDER 21 PSYCH
WV0001287002OtherUNDER 21 PSYCH