MEDICARE: ST VINCENT HOSPITAL & HEALTH CARE CENTER INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy
2	333600000X	Pharmacy
3	3336I0012X	Institutional Pharmacy	60005525A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2118555	OTHER		PK

General Provider Information

NPI Number	:	1699912444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST VINCENT HOSPITAL & HEALTH CARE CENTER INC

Provider Business Mailing Address
First Line	:	8450 N PAYNE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6620
Country	:	US
Telephone Number	:	317-338-4488
Fax Number	:	317-338-4479

Provider Business Practice Location Address
First Line	:	8450 N PAYNE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6620
Country	:	US
Telephone Number	:	317-338-4488
Fax Number	:	317-338-4479

Authorized Official
Title or Position	:	MANAGER AMBULATORY PHARMACY
Name	:	WENDY LEMASTERS
Credential	:
Telephone Number	:	317-338-2097

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	12/31/2015

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