Provider Demographics
NPI:1932417854
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-947-0551
Mailing Address - Street 1:1400 S LAKE PARK AVE
Mailing Address - Street 2:105
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6790
Mailing Address - Country:US
Mailing Address - Phone:219-942-5544
Mailing Address - Fax:219-942-5599
Practice Address - Street 1:10607 RANDOLPH ST
Practice Address - Street 2:C
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7505
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:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty