1235230046 NPI number — SAINT JOSEPH HEALTH SYSTEM, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235230046 NPI number — SAINT JOSEPH HEALTH SYSTEM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT JOSEPH HEALTH SYSTEM, 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:
CHI SAINT JOSEPH MOUNT STERLING SNF
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:
1235230046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 FALCON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT STERLING
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40353-9792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-498-1220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 FALCON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353-9792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-498-1220
Provider Business Practice Location Address Fax Number:
859-498-5155
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOLAN
Authorized Official First Name:
BENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-497-5000

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  100339 , 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: 032024300 . This is a "BLACK LUNG SWING" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50 00034 . This is a "UNITED HEALTHCARE SWING" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100106540 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054540 . This is a "ANTHEM SWING BED UNIT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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