# SAINT JOHN HEALTH SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Anderson Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396773461
- **Authorized official:** D BRUCE HAGA (VICE PRESIDENT)
- **Authorized official phone:** (317) 583-3087

## Contact information

- **Practice address:** 141 W 22ND ST, ANDERSON, IN 46016-4304
- **Practice address phone:** (765) 641-7100
- **Practice address fax:** (765) 641-7115
- **Mailing address:** 10330 N MERIDIAN ST, SUITE 201, INDIANAPOLIS, IN 46290-1024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/29/2006
- **Last updated:** 12/03/2007