Provider Demographics
NPI:1841233061
Name:ST. VINCENT WILLIAMSPORT HOSPITAL
Entity Type:Organization
Organization Name:ST. VINCENT WILLIAMSPORT HOSPITAL
Other - Org Name:ST. VINCENT NORTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLATT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:765-762-4000
Mailing Address - Street 1:1731 RINGER LANE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47993-8900
Mailing Address - Country:US
Mailing Address - Phone:765-762-9000
Mailing Address - Fax:
Practice Address - Street 1:1731 RINGER LANE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:IN
Practice Address - Zip Code:47993-8900
Practice Address - Country:US
Practice Address - Phone:765-762-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT WILLIAMSPORT HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050050921261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200370100AMedicaid
IN153993Medicare Oscar/Certification
IN870420Medicare PIN