Provider Demographics
NPI:1932249364
Name:ST. VINCENT WOMEN'S HEALTH BOUTIQUE
Entity Type:Organization
Organization Name:ST. VINCENT WOMEN'S HEALTH BOUTIQUE
Other - Org Name:ST. VINCENT WOMEN'S HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:317-338-8866
Mailing Address - Street 1:8550 NAAB RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1967
Mailing Address - Country:US
Mailing Address - Phone:317-338-8866
Mailing Address - Fax:317-338-8948
Practice Address - Street 1:8550 NAAB RD
Practice Address - Street 2:SUITE 201
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1967
Practice Address - Country:US
Practice Address - Phone:317-338-8866
Practice Address - Fax:317-338-8948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT HOSPITAL AND HEALTH CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0809250001Medicare NSC