Provider Demographics
NPI:1851780266
Name:ST VINCENT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ST VINCENT MEDICAL GROUP INC
Other - Org Name:ST VINCENT WOMEN'S HEALTH BOUTIQUE
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-583-3078
Mailing Address - Street 1:10330 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13420 N MERIDIAN ST
Practice Address - Street 2:#115
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1580
Practice Address - Country:US
Practice Address - Phone:317-582-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies