Provider Demographics
NPI:1720115264
Name:ST MARYS HEALTH, INC.
Entity Type:Organization
Organization Name:ST MARYS HEALTH, INC.
Other - Org Name:ASCENSION ST. VINCENT EVANSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-485-1502
Mailing Address - Street 1:3700 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47750-0001
Mailing Address - Country:US
Mailing Address - Phone:812-485-4000
Mailing Address - Fax:812-485-6839
Practice Address - Street 1:3700 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47750-0001
Practice Address - Country:US
Practice Address - Phone:812-485-4000
Practice Address - Fax:812-485-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN03193416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200472310AMedicaid
KY55000293Medicaid
IL=========004Medicaid