Provider Demographics
NPI:1699748996
Name:ST MARYS HOSPITAL
Entity type:Organization
Organization Name:ST MARYS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RANUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-594-7836
Mailing Address - Street 1:350 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2840
Mailing Address - Country:US
Mailing Address - Phone:973-594-7836
Mailing Address - Fax:973-365-4545
Practice Address - Street 1:350 BOULEVARD
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2840
Practice Address - Country:US
Practice Address - Phone:973-594-7836
Practice Address - Fax:973-365-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11606282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31S006Medicare PIN
NJ310006Medicare PIN