NPIMap

Organization Active NPI

St. Mary'S Physicians' Health Group, LLC

  • Internal Medicine Physician
  • Evansville, IN
National Provider Identifier
1124289517
Registry record updated Sep 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01037535A Issued in IN
Legal business name
ST. MARY'S PHYSICIANS' HEALTH GROUP, LLC
Practice address
801 Saint Marys Dr
Suite 302-E
Evansville, IN 47714-0511
Phone
(812) 485-4141
NPI assigned
Jun 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Karen Keil
Title
Operations Manager
Phone
(812) 485-1827

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 01037535A IN Primary

Addresses

Primary practice location

801 Saint Marys Dr
Suite 302-E
Evansville, IN 47714-0511

Mailing address

801 Saint Marys Dr
Suite 302-E
Evansville, IN 47714-0511
Phone (812) 485-4141

Other identifiers 1

IdentifierTypeStateIssuer
200903430EMedicaidIN

Other names 1

  • Bryan Glynn Laura Doing business as

National Provider Directory

National Provider Directory

Locations

801 Saint Marys Dr
Ste 302E
Evansville, IN 47714
Phone (812) 474-1500

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315785600000",
    "number": "1124289517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SAINT MARYS DR",
            "address_2": "SUITE 302-E",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140511",
            "telephone_number": "812-485-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SAINT MARYS DR",
            "address_2": "SUITE 302-E",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140511",
            "telephone_number": "812-485-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S PHYSICIANS' HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2011-09-12",
        "status": "A",
        "authorized_official_last_name": "KEIL",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "812-485-1827"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01037535A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200903430E",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bryan Glynn Laura",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.