Provider Demographics
NPI:1871964825
Name:ST. VINCENT HOSPITAL
Entity type:Organization
Organization Name:ST. VINCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-215-6422
Mailing Address - Street 1:8227 NORTHWEST BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8227 NORTHWEST BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1387
Practice Address - Country:US
Practice Address - Phone:317-415-5795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002132A246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty