Provider Demographics
NPI:1477663847
Name:ST. VINCENT MADISON COUNTY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:ST. VINCENT MADISON COUNTY HEALTH SYSTEM, INC.
Other - Org Name:DR. DAVID DEWAR OF SAINT JOHNS
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:D.
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-583-3087
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 1:11 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:IN
Practice Address - Zip Code:46017-1057
Practice Address - Country:US
Practice Address - Phone:765-378-1572
Practice Address - Fax:765-378-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN250960Medicare PIN