# ST VINCENT RANDOLPH HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family and Occupational Medicine of Ridgeville
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497748974
- **Authorized official:** MR. WAYNE G DESCHAMBEAU (ADMINISTRATOR)
- **Authorized official phone:** (765) 584-0141

## Contact information

- **Practice address:** 105 E 2ND ST, RIDGEVILLE, IN 47380-1325
- **Practice address phone:** (765) 857-2523
- **Practice address fax:** (765) 584-0551
- **Mailing address:** PO BOX 428, WINCHESTER, IN 47394-0428
- **Mailing address phone:** (765) 857-2523
- **Mailing address fax:** (765) 584-0551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/30/2005
- **Last updated:** 08/22/2020