Healthcare Provider Details

I. General information

NPI: 1912073818
Provider Name (Legal Business Name): SAINT JOHNS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/21/2022
Certification Date:
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 TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. PHILIP D HILGER
Title or Position: DIRECTOR
Credential:
Phone: 765-646-8243