Provider Demographics
NPI:1912946625
Name:ST. VINCENT MADISON COUNTY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:ST. VINCENT MADISON COUNTY HEALTH SYSTEM, INC.
Other - Org Name:ST. VINCENT MERCY HOSPITAL (SWING BED PROGRAM)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF NURSING, ST. VINCENT ME
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-552-4600
Mailing Address - Street 1:1331 S A ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-1942
Mailing Address - Country:US
Mailing Address - Phone:765-552-4600
Mailing Address - Fax:765-552-4775
Practice Address - Street 1:1331 S A ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1942
Practice Address - Country:US
Practice Address - Phone:765-552-4600
Practice Address - Fax:765-552-4775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT MERCY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060050832282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100268370Medicaid
IN15Z308Medicare Oscar/Certification
IN940240Medicare PIN