Provider Demographics
NPI:1467525634
Name:ST. VINCENT CLAY HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. VINCENT CLAY HOSPITAL, INC.
Other - Org Name:SWING BED
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-442-2602
Mailing Address - Street 1:1206 E NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2718
Mailing Address - Country:US
Mailing Address - Phone:812-442-2500
Mailing Address - Fax:812-442-2605
Practice Address - Street 1:1206 E NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2718
Practice Address - Country:US
Practice Address - Phone:812-442-2500
Practice Address - Fax:812-442-2605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT CLAY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-16
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060050461282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15Z309Medicare Oscar/Certification
IN940140Medicare PIN