Provider Demographics
NPI:1669442802
Name:ST. VINCENT CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:ST. VINCENT CHILDREN'S HOSPITAL
Other - Org Name:MEDICAL GENETICS & NEURODEVELOPMENTAL CT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:317-338-5288
Mailing Address - Street 1:8402 HARCOURT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2074
Mailing Address - Country:US
Mailing Address - Phone:317-338-5288
Mailing Address - Fax:317-388-7154
Practice Address - Street 1:7230 FOX HOLLOW RDG
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8202
Practice Address - Country:US
Practice Address - Phone:317-338-5288
Practice Address - Fax:317-388-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1044143261Q00000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH10379Medicare UPIN
IN147730AMedicare ID - Type Unspecified