Provider Demographics
NPI:1972872992
Name:ST MARY'S HOSPITAL
Entity Type:Organization
Organization Name:ST MARY'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ER CRISIS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:312-770-3501
Mailing Address - Street 1:3220 N KILDARE
Mailing Address - Street 2:
Mailing Address - City:CHGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641
Mailing Address - Country:US
Mailing Address - Phone:773-908-2242
Mailing Address - Fax:
Practice Address - Street 1:2233 W DIVISION
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:312-770-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital