Provider Demographics
NPI:1710951801
Name:ST VINCENT CHARITY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST VINCENT CHARITY MEDICAL CENTER
Other - Org Name:ST VINCENT CHARITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSNACZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-363-7718
Mailing Address - Street 1:6935 TREELINE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3393
Mailing Address - Country:US
Mailing Address - Phone:440-746-3401
Mailing Address - Fax:440-746-3405
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-861-6200
Practice Address - Fax:440-746-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34189345202OtherBUREAU WORKERS' COMPENSAT
016984000OtherMAGELLAN BEHAVIORAL HLTH
OH2137410001OtherCARESOURCE
OH3009523Medicaid
0009438OtherAETNA US HEALTHCARE
000000157500OtherANTHEM
341893452001OtherCHAMPUS
OH7649709OtherPEOPLES HEALTH PLAN
OH34189342007OtherMEDICAL MUTUAL OF OHIO CD
OH341893452005OtherMEDICAL MUTUAL OF OHIO
5000072OtherUNITED HEALTHCARE
615124400OtherDEPARTMENT OF LABOR
OH7649709Medicaid
304978OtherBLACK LUNG
OH81312OtherQUALCHOICE
OH7649709OtherPEOPLES HEALTH PLAN
OH81312OtherQUALCHOICE
615124400OtherDEPARTMENT OF LABOR