Henry, Mary Martin
Henry, Mary Martin is an individual health care provider with primary practice located at 6800 State Route 162 , Maryville IL 62062-8521. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cytopathology, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is her primary health care specialty. Henry, Mary Martin can be contacted via phone (618) 288-5711.Contact Information
Primary practice address
6800 State Route 162
Maryville IL 62062-8521
Phone: (618) 288-5711
Fax: (314) 977-7615
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cytopathology | 207ZC0500X | R1J04 | Missouri |
| Allopathic & Osteopathic Physicians / Cytopathology | 207ZC0500X | 036137460 | Illinois |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | R1J04 | Missouri |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 04-21754 | Kansas |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 036137460 | Illinois |
Profile Details
| NPI number | 1144283136 |
|---|---|
| LBN Legal business name | Henry, Mary Martin |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 10th, 2006 |
| Last updated | Jan 26th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144283136 | NPPES |
| Kansas | Other | 705958 | KS BCBS |
| Kansas | MEDICAID | 100257620A | KS BCBS |
| Kansas | MEDICAID | 208616508 | KS BCBS |
| Kansas | Other | 14731031 | KS BCBS |
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