Provider Demographics
NPI:1871869917
Name:ST. VINCENT HOSPITAL
Entity type:Organization
Organization Name:ST. VINCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:317-415-9265
Mailing Address - Street 1:13914 STATE ROAD 238 E
Mailing Address - Street 2:#206
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-5506
Mailing Address - Country:US
Mailing Address - Phone:317-415-9260
Mailing Address - Fax:317-415-9264
Practice Address - Street 1:13914 STATE ROAD 238 E
Practice Address - Street 2:#206
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-5506
Practice Address - Country:US
Practice Address - Phone:317-415-9260
Practice Address - Fax:317-415-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002486A283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital