Provider Demographics
NPI:1952941585
Name:ST. VINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE, INC.
Entity Type:Organization
Organization Name:ST. VINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE, INC.
Other - Org Name:ASCENSION ST. VINCENT WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-338-6234
Mailing Address - Street 1:250 W 96TH ST STE 520
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1033 E MOUNT PLEASANT RD STE D
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-7149
Practice Address - Country:US
Practice Address - Phone:888-492-8722
Practice Address - Fax:812-491-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-11
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty