Provider Demographics
NPI:1992022958
Name:ST MARY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ST MARY MEDICAL CENTER INC
Other - Org Name:ST MARY CARE NETWORK
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 1:9660 WICKER AVE
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9487
Mailing Address - Country:US
Mailing Address - Phone:219-226-2203
Mailing Address - Fax:219-226-2202
Practice Address - Street 1:1400 S LAKE PARK AVE
Practice Address - Street 2:STE 105
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6790
Practice Address - Country:US
Practice Address - Phone:219-942-5544
Practice Address - Fax:219-942-5599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST MARY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty