Provider Demographics
NPI:1184898736
Name:ST VINCENT MEDICAL CENTER
Entity type:Organization
Organization Name:ST VINCENT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-484-7067
Mailing Address - Street 1:2131 WEST THIRD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-0992
Mailing Address - Country:US
Mailing Address - Phone:213-484-7111
Mailing Address - Fax:
Practice Address - Street 1:2131 WEST THIRD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-0992
Practice Address - Country:US
Practice Address - Phone:213-484-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2017-04-03
Deactivation Date:2014-08-04
Deactivation Code:
Reactivation Date:2017-04-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30502HMedicaid
CAZZT40502HMedicaid
CALTC5437GMedicaid
CAZZT40502HMedicaid