Provider Demographics
NPI:1821091802
Name:VINCENNES SURGERY CENTER LP
Entity Type:Organization
Organization Name:VINCENNES SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:VIECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-886-6063
Mailing Address - Street 1:300 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1252
Mailing Address - Country:US
Mailing Address - Phone:812-886-6063
Mailing Address - Fax:
Practice Address - Street 1:300 N 1ST ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1252
Practice Address - Country:US
Practice Address - Phone:812-886-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INZR5020Medicare ID - Type Unspecified