1669442802 NPI number — ST. VINCENT CHILDREN'S HOSPITAL

Table of content: (NPI 1669442802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669442802 NPI number — ST. VINCENT CHILDREN'S HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. VINCENT CHILDREN'S HOSPITAL
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:
MEDICAL GENETICS & NEURODEVELOPMENTAL CT
Provider Other Organization Name Type Code:
5
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:
1669442802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8402 HARCOURT RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-2074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-338-5288
Provider Business Mailing Address Fax Number:
317-388-7154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7230 FOX HOLLOW RDG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZIONSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46077-8202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-338-5288
Provider Business Practice Location Address Fax Number:
317-388-7154
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESCOBAR
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
317-338-5288

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1044143 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 282NC2000X , with the licence number: 1044143 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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