Provider Demographics
NPI:1083781892
Name:ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC.
Other - Org Name:TCU SNF
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DR PH
Authorized Official - Phone:317-338-2273
Mailing Address - Street 1:2001 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1902
Mailing Address - Country:US
Mailing Address - Phone:317-338-2345
Mailing Address - Fax:
Practice Address - Street 1:2001 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1902
Practice Address - Country:US
Practice Address - Phone:317-338-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-005075-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155748Medicare Oscar/Certification