Provider Demographics
NPI:1891431896
Name:ST. VINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE, INC.
Entity Type:Organization
Organization Name:ST. VINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE, INC.
Other - Org Name:PERSONALIZED HEALTH CARE ZIONSVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO (AMG)
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-338-6234
Mailing Address - Street 1:10801 N MICHIGAN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10801 N MICHIGAN RD STE 205
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8171
Practice Address - Country:US
Practice Address - Phone:317-733-1829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty