Organization
SAINT JOHN HEALTH SYSTEM
Active
Parent organization
ST.VINCENT MADISON COUNTY HEALTH SYSTEM INC
Other names
Saint John's Medical Supplies
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST.VINCENT MADISON COUNTY HEALTH SYSTEM INC
Authorized official
MR. DANTE OTIS PHILLIPS (DME CONSULTANT)
(765) 683-3201
Entity
Organization
Contact information
Practice address
1907 W SYCAMORE ST, 3RD FLOOR, KOKOMO, IN 46901-5148
(765) 236-8300
(765) 236-8302
Mailing address
2015 JACKSON ST, RM 248, ANDERSON, IN 46016-4337
(765) 683-3201
(765) 646-8625
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
69000392A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000247286
ANTHEM
IN
05
—
200408950A
—
IN
Enumeration date
03/01/2010
Last updated
12/20/2011
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