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General NPI Number Information
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NPI Number | 1033304241
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Entity Type | Organization
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Legal Business Name | ST. VINCENT RANDOLPH HOSPITAL, INC.
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 473 E GREENVILLE AVE
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City | WINCHESTER
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State | IN
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Zip | 47394-9436
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Country | US
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Telephone | 765-584-0339
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Fax |
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Provider Business Mailing Address
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Address Line | 10330 N MERIDIAN ST SUITE 201
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City | INDIANAPOLIS
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State | IN
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Zip | 46290-1024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | D. BRUCE HAGA
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Credential |
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Telephone | 317-583-3087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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