Provider Demographics
NPI:1316205495
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:ST. VINCENT PEDIATRIC SUBSPECIALTIES
Other - Org Type:Other Name
Authorized Official - Title/Position:SYSTEM EXECUTIVE REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-583-3194
Mailing Address - Street 1:10330 N MERIDIAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8402 HARCOURT RD
Practice Address - Street 2:SUITE 402
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2074
Practice Address - Country:US
Practice Address - Phone:317-338-9450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200901000IMedicaid
IN223110Medicare Oscar/Certification