1679578850 NPI number — ST. VINCENT ANDERSON REGIONAL HOSPITAL, INC.

Table of content: (NPI 1679578850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679578850 NPI number — ST. VINCENT ANDERSON REGIONAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. VINCENT ANDERSON REGIONAL HOSPITAL, INC.
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:
ASCENSION ST. VINCENT ANDERSON
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:
1679578850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2015 JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46016-4337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-646-8243
Provider Business Mailing Address Fax Number:
765-646-8655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2015 JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46016-4337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-646-8243
Provider Business Practice Location Address Fax Number:
765-646-8655
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBSON
Authorized Official First Name:
BECKY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
317-582-7219

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 050050781 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200408600R , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200409060 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000244149 . This is a "ANTHEM HOME HEALTH PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200408600Q , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK6867 . This is a "MEDICARE PIN OTHER ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000244683 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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