Provider Demographics
NPI:1538236385
Name:ST VINCENT JENNINGS HOSPITAL INC
Entity type:Organization
Organization Name:ST VINCENT JENNINGS HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-352-4200
Mailing Address - Street 1:301 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1063
Mailing Address - Country:US
Mailing Address - Phone:812-352-4200
Mailing Address - Fax:812-352-4201
Practice Address - Street 1:301 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1063
Practice Address - Country:US
Practice Address - Phone:812-352-4200
Practice Address - Fax:812-352-4201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT JENNINGS HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-005108-2282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200260180Medicaid
IN200260180Medicaid
IN15Z303Medicare Oscar/Certification