Provider Demographics
NPI:1447321997
Name:ST CLARE HEALTH NETWORK
Entity type:Organization
Organization Name:ST CLARE HEALTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-362-3100
Mailing Address - Street 1:1710 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1033
Mailing Address - Country:US
Mailing Address - Phone:765-364-9720
Mailing Address - Fax:765-364-9740
Practice Address - Street 1:1630 LAFAYETTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1090
Practice Address - Country:US
Practice Address - Phone:765-364-9720
Practice Address - Fax:765-364-9740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CLARE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000386762OtherANTHEM PIN
IN200214400BMedicaid
INC14676Medicare UPIN