1558386193 NPI number — SAINT JOSEPH HEALTH SYSTEM INC

Table of content: (NPI 1558386193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558386193 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:
BETSY LAYNE CLINIC
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:
1558386193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40743-0936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-330-7840
Provider Business Mailing Address Fax Number:
606-330-7825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9350 US HIGHWAY 23 SOUTH, STE3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41659-9047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-478-3636
Provider Business Practice Location Address Fax Number:
606-478-3635
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HALE
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISION VICE PRESIDENT, FINANCE
Authorized Official Telephone Number:
859-227-7039

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 183421 , issued by the state of ( KY ) . This identifiers is of the category "MEDICARE OSCAR/CERTIFICATION".
  • Identifier: 7100106230 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".