Healthcare Provider Details

I. General information

NPI: 1467690867
Provider Name (Legal Business Name): ST VINCENT HOSPITAL & HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 NAAB RD
INDIANAPOLIS IN
46260-1972
US

IV. Provider business mailing address

8414 NAAB RD
INDIANAPOLIS IN
46260-1972
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7759
  • Fax: 317-338-7535
Mailing address:
  • Phone: 317-338-7759
  • Fax: 317-338-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60005960A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WENDY LEMASTERS
Title or Position: MANAGER AMBULATORY SERVICES
Credential:
Phone: 317-338-2097