Organization
ST. VINCENT RANDOLPH HOSPITAL, INC.
Active
Other names
HOSPITALIST PROGRAM
Organization subpart
No
Provider details
NPI number
Authorized official
D. BRUCE HAGA (VICE PRESIDENT)
(317) 583-3087
Entity
Organization
Contact information
Practice address
473 E GREENVILLE AVE, WINCHESTER, IN 47394-9436
(765) 584-0339
Mailing address
10330 N MERIDIAN ST, SUITE 201, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2634117
—
OH
Enumeration date
09/11/2007
Last updated
03/04/2008
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