1598904351 NPI number — ST.VINCENT MADISON COUNTY HEALTH SYSTEM

Table of content: (NPI 1598904351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598904351 NPI number — ST.VINCENT MADISON COUNTY HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST.VINCENT MADISON COUNTY HEALTH SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAINT JOHN'S MEDICAL SUPPLIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598904351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46016-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-683-3201
Provider Business Mailing Address Fax Number:
765-646-8625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13914 STATE ROAD 238 E
Provider Second Line Business Practice Location Address:
ROOM 300
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46037-5506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-415-9106
Provider Business Practice Location Address Fax Number:
765-646-8625
Provider Enumeration Date:
02/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
DANTE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
DME CONSULTANT
Authorized Official Telephone Number:
765-683-3201

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200408950A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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