Provider Demographics
NPI:1093137911
Name:ST. VINCENT HOSPITAL & HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:ST. VINCENT HOSPITAL & HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HUEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LAT, ATC
Authorized Official - Phone:317-750-9584
Mailing Address - Street 1:8227 NORTHWEST BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1386
Mailing Address - Country:US
Mailing Address - Phone:317-415-5747
Mailing Address - Fax:
Practice Address - Street 1:8227 NORTHWEST BLVD STE 160
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1386
Practice Address - Country:US
Practice Address - Phone:317-415-5747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002185A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty