# ST. MARY ADULT MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942481965
- **Authorized official:** DINA M MOURICE NP (NP)
- **Authorized official phone:** (317) 293-9039

## Contact information

- **Practice address:** 4803 W 71ST ST, INDIANAPOLIS, IN 46268-2149
- **Practice address phone:** (317) 293-9039
- **Practice address fax:** (855) 538-6177
- **Mailing address:** 4803 W 71ST ST, INDIANAPOLIS, IN 46268-2149
- **Mailing address phone:** (317) 293-9039
- **Mailing address fax:** (855) 538-6177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/19/2007
- **Last updated:** 08/15/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201378550 | — | IN |