Provider Demographics
NPI:1598904351
Name:ST.VINCENT MADISON COUNTY HEALTH SYSTEM
Entity Type:Organization
Organization Name:ST.VINCENT MADISON COUNTY HEALTH SYSTEM
Other - Org Name:SAINT JOHN'S MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DME CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:O
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-683-3201
Mailing Address - Street 1:2020 MERIDIAN ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4346
Mailing Address - Country:US
Mailing Address - Phone:765-683-3201
Mailing Address - Fax:765-646-8625
Practice Address - Street 1:13914 STATE ROAD 238 E
Practice Address - Street 2:ROOM 300
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-5506
Practice Address - Country:US
Practice Address - Phone:317-415-9106
Practice Address - Fax:765-646-8625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST.VINCENT MADISON COUNTY HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-18
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200408950AMedicaid
IN4717730003Medicare NSC