ST VINCENT PHYSICIAN SERVICES HOSPITAL AND HEALTH CARE CENTER

Provider Demographics

• NPI: 1669422234
• Name: ST VINCENT PHYSICIAN SERVICES HOSPITAL AND HEALTH CARE CENTER
• Entity type: Organization
• Organization Name: ST VINCENT PHYSICIAN SERVICES HOSPITAL AND HEALTH CARE CENTER
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CFO (SVMG)
• Authorized Official - First Name: BRIAN
• Authorized Official - Last Name: MORRIS
• Authorized Official - Phone: 317-338-6234
• 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: 2006-05-12
• Last Update Date: 2021-10-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	103G00000X	Behavioral Health & Social Service Providers	Clinical Neuropsychologist		Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Multi-Specialty
No	207QS0010X	Allopathic & Osteopathic Physicians	Family Medicine	Sports Medicine	Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RG0300X	Allopathic & Osteopathic Physicians	Internal Medicine	Geriatric Medicine	Group - Multi-Specialty
No	207RS0010X	Allopathic & Osteopathic Physicians	Internal Medicine	Sports Medicine	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207VX0201X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Gynecologic Oncology	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	100055800A	Medicaid
IN	100055800C	Medicaid
IN	100345550A	Medicaid
IN	100055800B	Medicaid
IN	100055800D	Medicaid
IN	200827600B	Medicaid
IN	100055800F	Medicaid
IN	200802910A	Medicaid
IN	100055800G	Medicaid
IN	200827600C	Medicaid
IN	100055800E	Medicaid
IN	200827600A	Medicaid
IN	100055800B	Medicaid