Provider Demographics
NPI:1851614192
Name:SAINT JOHN HEALTH SYSTEM
Entity Type:Organization
Organization Name:SAINT JOHN HEALTH SYSTEM
Other - Org Name:SAINT JOHN'S MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DME CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:OTIS
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-683-3201
Mailing Address - Street 1:2015 JACKSON ST
Mailing Address - Street 2:RM 248
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4337
Mailing Address - Country:US
Mailing Address - Phone:765-683-3201
Mailing Address - Fax:765-646-8625
Practice Address - Street 1:1907 W SYCAMORE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5148
Practice Address - Country:US
Practice Address - Phone:765-236-8300
Practice Address - Fax:765-236-8302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST.VINCENT MADISON COUNTY HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-01
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000392A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200408950AMedicaid
IN000000247286OtherANTHEM
4717730004Medicare NSC