Provider Demographics
NPI:1720555170
Name:ST. VINCENT MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ST. VINCENT MEDICAL GROUP, INC.
Other - Org Name:ASCENSION MEDICAL GROUP ST. VINCENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-338-6234
Mailing Address - Street 1:250 W 96TH ST # 520
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 INNOVATION PARKWAY
Practice Address - Street 2:#150
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3625
Practice Address - Country:US
Practice Address - Phone:317-583-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory