Healthcare Provider Details

I. General information

NPI: 1679578850
Provider Name (Legal Business Name): ST. VINCENT ANDERSON REGIONAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 JACKSON ST
ANDERSON IN
46016-4337
US

IV. Provider business mailing address

2015 JACKSON ST
ANDERSON IN
46016-4337
US

V. Phone/Fax

Practice location:
  • Phone: 765-646-8243
  • Fax: 765-646-8655
Mailing address:
  • Phone: 765-646-8243
  • Fax: 765-646-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number050050781
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: BECKY JACOBSON
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 317-582-7219