Provider Demographics
NPI:1316497811
Name:ST. MARY'S MEDICAL CENTER OF EVANSVILLE
Entity type:Organization
Organization Name:ST. MARY'S MEDICAL CENTER OF EVANSVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-485-7362
Mailing Address - Street 1:14020 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725
Mailing Address - Country:US
Mailing Address - Phone:812-485-4695
Mailing Address - Fax:
Practice Address - Street 1:14020 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725
Practice Address - Country:US
Practice Address - Phone:812-485-4695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARY'S MEDICAL CENTER OF EVANSVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy