Organization
ST. MARY'S AT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY J HALL (EXECUTIVE DIRECTOR)
(812) 485-4079
Entity
Organization
Contact information
Practice address
6840 LOGAN DR, SUITE E, EVANSVILLE, IN 47715-8253
(812) 485-7950
(812) 485-7724
Mailing address
PO BOX 15187, EVANSVILLE, IN 47716-0187
(812) 485-7950
(812) 485-7724
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
007035
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000222679
BLUE CROSS IV
IN
Enumeration date
05/29/2007
Last updated
08/24/2007
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