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Organization
SAINT VINCENT OF MADISON COUNTY
Active
Organization
SAINT VINCENT OF MADISON COUNTY
Active
Other names
Saint John's Medical Supplies
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANTE O PHILLIPS (DIRECTOR)
(765) 683-3201
Entity
Organization
Contact information
Practice address
1907 W SYCAMORE ST, 3RD FLOOR, KOKOMO, IN 46901-5148
(765) 236-8300
(765) 236-8302
Mailing address
2020 MERIDIAN ST, SUITE 180, ANDERSON, IN 46016-4346
(765) 683-3201
(765) 646-8625
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
69000392A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200408950A
—
IN
Enumeration date
04/23/2008
Last updated
03/16/2010
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