Provider Demographics
NPI:1982088902
Name:ST. MARY'S MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. MARY'S MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT COORDINTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-655-5426
Mailing Address - Street 1:201 NW R D MIZE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2513
Mailing Address - Country:US
Mailing Address - Phone:816-655-5426
Mailing Address - Fax:816-655-5408
Practice Address - Street 1:201 NW R D MIZE RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2513
Practice Address - Country:US
Practice Address - Phone:816-655-5426
Practice Address - Fax:816-655-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020395282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital