1598904351 NPI number — ST.VINCENT MADISON COUNTY HEALTH SYSTEM

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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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