Healthcare Provider Details

I. General information

NPI: 1336236025
Provider Name (Legal Business Name): SAINT JOHN HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 MERIDIAN ST SUITE 180
ANDERSON IN
46016-4346
US

IV. Provider business mailing address

2015 JACKSON ST RM 248
ANDERSON IN
46016-4337
US

V. Phone/Fax

Practice location:
  • Phone: 765-646-8366
  • Fax: 765-683-3202
Mailing address:
  • Phone: 765-683-3201
  • Fax: 765-646-8625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number69000167A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number69000167A
License Number StateIN

VIII. Authorized Official

Name: MR. DANTE O PHILLIPS
Title or Position: DME CONSULTANT
Credential:
Phone: 765-683-3201