Organization
ST. VINCENT PHYSICIAN NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MCANDREWS (VICE PRESIDENT)
(317) 583-3194
Entity
Organization
Contact information
Practice address
105 EAST 2ND STREET, RIDGEVILLE, IN 47380-1325
(765) 857-2523
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
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-3880
MEDICARE PART A
IN
05
—
200817010
—
IN
Enumeration date
09/19/2006
Last updated
08/10/2011
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