Provider Demographics
NPI:1336315563
Name:ST. VINCENT HEALTH SERVICES
Entity Type:Organization
Organization Name:ST. VINCENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ANDRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-345-7399
Mailing Address - Street 1:2001 W 86TH STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1902
Mailing Address - Country:US
Mailing Address - Phone:317-338-2281
Mailing Address - Fax:
Practice Address - Street 1:2001 W 86TH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1902
Practice Address - Country:US
Practice Address - Phone:317-338-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11012731A261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service