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Contact Information

MARY M HENRY, MD
6800 STATE ROUTE 162
MARYVILLE, IL62062-8521
 Phone: 618-288-5711
 Fax: 314-977-7615
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anatomic Pathology & Clinical Pathology

207ZP0102X 22 Physician/Pathology
 

Cytopathology

207ZC0500X 22 Physician/Pathology
Indicates primary specialty

NPI Profile & details for MARY M HENRY · (Female)

NPI # 1144283136
Status Active
Credentials MD
Entity Individual
Enumeration date 04/10/2006
Last updated 01/26/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036137460
  • KS License # 04-21754
  • MO License # R1J04
  • KS Medicaid 100257620A
  • MO Medicaid 208616508
  • Other 14731031 KS CITY BCBS
  • KS Other 705958 KS BCBS
Hospital affiliation(s)
  • GOOD SAMARITAN REGIONAL HEALTH CENTER - (Acute Care)
    1 GOOD SAMARITAN WAY
    MOUNT VERNON, IL 62864
  • OVERLAND PARK REG MED CTR - (Acute Care)
    10500 QUIVIRA ROAD
    OVERLAND PARK, KS 66215
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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