Provider Demographics
NPI:1760734602
Name:ST. VINCENT HEALTHCARE
Entity Type:Organization
Organization Name:ST. VINCENT HEALTHCARE
Other - Org Name:ST. VINCENT PHYSICIAN NETWORK CODY MEDICAL ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-3070
Mailing Address - Street 1:1025 9TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3441
Mailing Address - Country:US
Mailing Address - Phone:307-587-5622
Mailing Address - Fax:307-587-5657
Practice Address - Street 1:1025 9TH ST
Practice Address - Street 2:STE B
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3441
Practice Address - Country:US
Practice Address - Phone:307-587-5622
Practice Address - Fax:307-587-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13258207RH0003X
MT12129261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW9821Medicare PIN