Healthcare Provider Details

I. General information

NPI: 1922937473
Provider Name (Legal Business Name): ST. VINCENT HEALTH WELLNESS AND PREVENTIVE CARE INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 E WABASH ST
FRANKFORT IN
46041-9400
US

IV. Provider business mailing address

2485 E WABASH ST
FRANKFORT IN
46041-9400
US

V. Phone/Fax

Practice location:
  • Phone: 765-656-3905
  • Fax: 765-656-3922
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DERIC ROBERTS
Title or Position: CFO
Credential:
Phone: 317-694-3987