Provider Demographics
NPI:1730130238
Name:ST. VINCENT RANDOLPH HOSPITAL, INC
Entity Type:Organization
Organization Name:ST. VINCENT RANDOLPH HOSPITAL, INC
Other - Org Name:ASCENSION ST. VINCENT RANDOLPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-584-0107
Mailing Address - Street 1:473 E GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-9436
Mailing Address - Country:US
Mailing Address - Phone:765-584-0004
Mailing Address - Fax:
Practice Address - Street 1:473 E GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9436
Practice Address - Country:US
Practice Address - Phone:765-584-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT RANDOLPH HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-005046-1275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN168790Medicare PIN
IN179230Medicare PIN
IN15Z301Medicare Oscar/Certification