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General NPI Number Information
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NPI Number | 1699045153
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Entity Type | Organization
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Legal Business Name | ST. VINCENT HEALTH
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 3525 W 126TH ST
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City | CARMEL
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State | IN
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Zip | 46032-9557
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Country | US
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Telephone | 317-733-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 5228 THRASHER DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3563
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Country | US
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Telephone | 317-281-5539
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Fax |
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Authorized Official
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Title or Position | CERTIFIED ATHLETIC TRAINER
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Name | BRITTANI MOORE
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Credential | ATC
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Telephone | 317-281-5539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36001755A
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License Number State | IN
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