1235139312 NPI number — JENNIE STUART MEDICAL CENTER INC

Table of content: (NPI 1235139312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235139312 NPI number — JENNIE STUART MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNIE STUART 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:
Provider Other Organization Name Type Code:
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:
1235139312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2400
Provider Second Line Business Mailing Address:
320 W 18TH ST
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42241-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-887-0100
Provider Business Mailing Address Fax Number:
270-887-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 W 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-887-0100
Provider Business Practice Location Address Fax Number:
270-887-9266
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
270-887-0100

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 6593432500 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 65939332 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 65941742 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 78903788 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 7100104890 , 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: 100068 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SF0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1066495 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01010859 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000212362 . This is a "BLUE CROSS PHYSICIAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100104890 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78903788 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 039724400 . This is a "KENTUCKY BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65939332 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054549 . This is a "BLUE CROSS PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6593432500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65941742 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163067200 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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