1740221795 NPI number — ST ELIZABETH MEDICAL CENTER, INC

Table of content: (NPI 1740221795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740221795 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 FT. THOMAS
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:
1740221795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2023
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:
85 N GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-572-3100
Provider Business Practice Location Address Fax Number:
859-578-5980
Provider Enumeration Date:
06/09/2006

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 , 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: 100059 , 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: 01010958 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013393707 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 183235200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52177254 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 610486447001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: STL0001N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01333707 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740221795 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740221795 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100116580 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304727771 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00372281X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 097491900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100276160A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740221795 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 404727780 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431633600 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200005300C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4111508 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 858433 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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