Provider Demographics
NPI:1679578850
Name:ST. VINCENT ANDERSON REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:ST. VINCENT ANDERSON REGIONAL HOSPITAL, INC.
Other - Org Name:ASCENSION ST. VINCENT ANDERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-582-7219
Mailing Address - Street 1:2015 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4337
Mailing Address - Country:US
Mailing Address - Phone:765-646-8243
Mailing Address - Fax:765-646-8655
Practice Address - Street 1:2015 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4337
Practice Address - Country:US
Practice Address - Phone:765-646-8243
Practice Address - Fax:765-646-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 273R00000X, 332S00000X
IN050050781282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No273R00000XHospital UnitsPsychiatric UnitGroup - Single Specialty
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200408600RMedicaid
IN200409060Medicaid
IN000000244149OtherANTHEM HOME HEALTH PIN
IN200408600QMedicaid
INCK6867OtherMEDICARE PIN OTHER ID
IN000000244683OtherANTHEM PROVIDER NUMBER
INCK6867OtherMEDICARE PIN OTHER ID
IN150088Medicare Oscar/Certification