ST VINCENT PEDIATRIC SUBSPECIALTIES

Provider Demographics

• NPI: 1013967736
• Name: ST VINCENT PEDIATRIC SUBSPECIALTIES
• Entity Type: Organization
• Organization Name: ST VINCENT PEDIATRIC SUBSPECIALTIES
• Authorized Official - Title/Position: VICE PRESIDENT
• Authorized Official - First Name: KEVIN
• Authorized Official - Last Name: MCANDREWS
• Authorized Official - Phone: 317-583-3194
• Mailing Address - Street 1: 10330 N MERIDIAN ST
• Mailing Address - Street 2: SUITE 201
• Mailing Address - City: INDIANAPOLIS
• Mailing Address - State: IN
• Mailing Address - Zip Code: 46290-1024
• Mailing Address - Country: US
• Practice Address - Street 1: 2001 W 86TH ST
• Practice Address - City: INDIANAPOLIS
• Practice Address - State: IN
• Practice Address - Zip Code: 46260-1902
• Practice Address - Country: US
• Practice Address - Phone: 317-338-2273
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: ST VINCENT HOSPITAL AND HEALTH CARE CENTER INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-05-11
• Last Update Date: 2014-11-17

Provider Licenses

State	License ID	Taxonomies
		1223X0400X, 207VM0101X, 207XP3100X, 207YP0228X, 2080A0000X, 2080N0001X, 2080P0202X, 2080P0205X, 2080P0207X, 2080P0214X, 208100000X, 2086S0120X, 208M00000X, 363L00000X
IN	050050751	208000000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	1223X0400X	Dental Providers	Dentist	Orthodontics and Dentofacial Orthopedics	Group - Multi-Specialty
No	207VM0101X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Maternal & Fetal Medicine	Group - Multi-Specialty
No	207XP3100X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Pediatric Orthopaedic Surgery	Group - Multi-Specialty
No	207YP0228X	Allopathic & Osteopathic Physicians	Otolaryngology	Pediatric Otolaryngology	Group - Multi-Specialty
No	2080A0000X	Allopathic & Osteopathic Physicians	Pediatrics	Adolescent Medicine	Group - Multi-Specialty
No	2080N0001X	Allopathic & Osteopathic Physicians	Pediatrics	Neonatal-Perinatal Medicine	Group - Multi-Specialty
No	2080P0202X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Cardiology	Group - Multi-Specialty
No	2080P0205X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Endocrinology	Group - Multi-Specialty
No	2080P0207X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Hematology-Oncology	Group - Multi-Specialty
No	2080P0214X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Pulmonology	Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	2086S0120X	Allopathic & Osteopathic Physicians	Surgery	Pediatric Surgery	Group - Multi-Specialty
No	208M00000X	Allopathic & Osteopathic Physicians	Hospitalist		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	200505130P	Medicaid
IN	200901000B	Medicaid
IN	200505130M	Medicaid
IN	200505130S	Medicaid
IN	200505130U	Medicaid
IN	200505130Y	Medicaid
IN	200505130I	Medicaid
IN	200505130C	Medicaid
IN	200505130J	Medicaid
IN	200505130R	Medicaid
IN	200505130V	Medicaid
IN	200505130X	Medicaid
IN	200505130E	Medicaid
IN	200505130F	Medicaid
IN	200505130K	Medicaid
IN	200505130L	Medicaid
IN	200505130O	Medicaid
IN	200505130H	Medicaid
IN	200505130N	Medicaid
IN	200505130W	Medicaid
OH	2602026	Medicaid
IN	200505130B	Medicaid
IN	200505130D	Medicaid
IN	200505130T	Medicaid
IN	200505130Z	Medicaid
IN	200901000A	Medicaid
IN	200505130A	Medicaid
IN	200505130G	Medicaid
IN	200505130Q	Medicaid
IN	200901000C	Medicaid
OH	2645178	Medicaid
IN	200901000A	Medicaid