Organization
ST. VINCENT CLAY HOSPITAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY LAUE (ADMINISTRATOR)
(812) 442-2602
Entity
Organization
Contact information
Practice address
1206 E NATIONAL AVE, BRAZIL, IN 47834-2718
(812) 442-2500
Mailing address
1206 E NATIONAL AVE, BRAZIL, IN 47834-2718
(812) 442-2500
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
060050461
IN
282NC0060X
Critical Access Hospital
Primary
060050461
IN
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200107350
—
IN
05
—
200348850A
—
IN
Enumeration date
05/10/2006
Last updated
04/01/2011
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