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General NPI Number Information
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NPI Number | 1790317964
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Entity Type | Organization
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Legal Business Name | ST. VINCENT MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 401 E MICHIGAN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1643
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Country | US
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Telephone | 317-713-8519
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Fax |
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Provider Business Mailing Address
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Address Line | 250 W 96TH ST STE 520
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1317
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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 | CFO
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Name | BRIAN MORRIS
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Credential |
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Telephone | 317-338-6234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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