1154365062 NPI number — ST ELIZABETH MEDICAL CENTER, INC

Table of content: (NPI 1154365062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154365062 NPI number — ST ELIZABETH MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST ELIZABETH MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST ELIZABETH FLORENCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154365062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-3403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-655-1889
Provider Business Mailing Address Fax Number:
859-578-5980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4900 HOUSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-212-5200
Provider Business Practice Location Address Fax Number:
859-578-5980
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RITCHEY-BALDWIN
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO (INTERIM)
Authorized Official Telephone Number:
859-655-0109

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  100273 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 100273 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1154365062 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431633600 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01754530 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200005300A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100116650 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806346000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00504765X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114934 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123999105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1766275 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304607380 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: SLH0045N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0413355 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117986 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1800045 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810017096 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33521 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01022193 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013436902 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0180045 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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