St Vincent Randolph Hospital
Organization Active NPI Rural Health Clinic/Center · Ridgeville, IN
NPI 1497748974 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1497748974
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ST VINCENT RANDOLPH HOSPITAL
- Practice address
- 105 E 2ND St
Ridgeville, IN 47380-1325 - Phone
- (765) 857-2523
- Fax
- (765) 584-0551
- NPI assigned
- Aug 30, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Wayne G Deschambeau
- Title
- Administrator
- Phone
- (765) 584-0141
Corporate family (same tax ID) 5
Member of 1
National Provider Directory
- Tax ID family
- St Vincent Randolph Hospita
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
105 E 2ND St
Ridgeville, IN 47380-1325
Mailing address
PO Box 428
Winchester, IN 47394-0428
Phone (765) 857-2523
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2281123 | Medicaid | IN | |
| 000000105462 | Other | IN | BC/BS GROUP # |
Other names
- Family and Occupational Medicine of Ridgeville
Other providers in Ridgeville, IN
- April L Dixon
- Tory Masters
- Reid Physician Associates, Inc.
- St. Vincent Physician Network, LLC
- St. Vincent Physician Network, LLC
- Carla Walker
All providers in Ridgeville, IN · Rural Health Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.