Provider Demographics
NPI:1083831994
Name:ST. VINCENT HOSPITAL
Entity Type:Organization
Organization Name:ST. VINCENT HOSPITAL
Other - Org Name:ST. VINCENT HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HOSPICE
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-338-4010
Mailing Address - Street 1:8450 N PAYNE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6620
Mailing Address - Country:US
Mailing Address - Phone:317-338-4040
Mailing Address - Fax:317-338-4044
Practice Address - Street 1:8450 N PAYNE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-6620
Practice Address - Country:US
Practice Address - Phone:317-338-4040
Practice Address - Fax:317-338-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07005241315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200162870AMedicaid
IN151507Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER