Provider Demographics
NPI:1881956167
Name:ST VINCENT FISHERS HOSPITAL INC
Entity type:Organization
Organization Name:ST VINCENT FISHERS HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-582-7219
Mailing Address - Street 1:13861 OLIO ROAD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-3487
Mailing Address - Country:US
Mailing Address - Phone:317-415-9000
Mailing Address - Fax:317-415-9048
Practice Address - Street 1:13861 OLIO ROAD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-3487
Practice Address - Country:US
Practice Address - Phone:317-415-9000
Practice Address - Fax:317-415-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-013137-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201174110AMedicaid
IN201174110AMedicaid