Provider Demographics
NPI: | 1003866740 |
---|---|
Name: | ST. VINCENT HOSPITAL & HEALTH CARE CENTER, INC. |
Entity Type: | Organization |
Organization Name: | ST. VINCENT HOSPITAL & HEALTH CARE CENTER, INC. |
Other - Org Name: | ST. VINCENT STRESS CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VICE PRESIDENT OF FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BETHANY |
Authorized Official - Middle Name: | LYNN |
Authorized Official - Last Name: | MORROW |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 765-437-4759 |
Mailing Address - Street 1: | 8401 HARCOURT RD |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46260-2036 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-338-4600 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8401 HARCOURT RD |
Practice Address - Street 2: | |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46260-2036 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-338-4600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-11 |
Last Update Date: | 2020-04-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 101YM0800X, 103T00000X, 103TC0700X, 1041C0700X, 106H00000X, 207QA0401X, 2084P0800X, 2084P0805X, 363L00000X, 363LF0000X, 364S00000X | ||
IN | 05-005075-1 | 273R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 273R00000X | Hospital Units | Psychiatric Unit | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 200064190 | Medicaid | |
IN | 200064190 | Medicaid | |
IN | 15S084 | Medicare Oscar/Certification | |
IN | 674540 | Medicare PIN | |
IN | 675560 | Medicare PIN |