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Organization

ST. MARY'S PHYSICIAN NETWORK LLC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY HODGKINSON (CFO)
(812) 485-4000
Entity
Organization

Contact information

Practice address
3700 WASHINGTON AVENUE, EVANSVILLE, IN 47750-0001
(812) 485-1220
Mailing address
PO BOX 359, EVANSVILLE, IN 47703-0359
(812) 485-1220

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
Primary
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
207RN0300X
Nephrology Physician
207RP1001X
Pulmonary Disease Physician
207V00000X
Obstetrics & Gynecology Physician
208000000X
Pediatrics Physician
2080S0012X
Pediatric Sleep Medicine Physician
208D00000X
General Practice Physician
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner
363LA2100X
Acute Care Nurse Practitioner
363LF0000X
Family Nurse Practitioner
363LP0200X
Pediatric Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200829650
IN
05
65945420
KY
01
DF3251
RR MEDICARE GRP#
IN
Enumeration date
06/18/2006
Last updated
08/17/2018
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