MEDICARE: ST. VINCENT PHYSICIAN NETWORK, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	207Q00000X	Family Medicine Physician
3	207R00000X	Internal Medicine Physician
4	208000000X	Pediatrics Physician
5	363LF0000X	Family Nurse Practitioner
6	363L00000X	Nurse Practitioner
7	261QR1300X	Rural Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15-3880	OTHER	IN	MEDICARE PART A

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285731737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. VINCENT PHYSICIAN NETWORK, LLC

Provider Business Mailing Address
First Line	:	10330 N MERIDIAN ST
Second Line	:	SUITE 201
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 EAST 2ND STREET
Second Line	:
City	:	RIDGEVILLE
State	:	IN
Zip	:	47380-1325
Country	:	US
Telephone Number	:	765-857-2523
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KEVIN MCANDREWS
Credential	:
Telephone Number	:	317-583-3194

Provider Enumeration Date	:	09/19/2006
Last Update Date	:	08/10/2011

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