1063675759 NPI number — ST ELIZABETH MEDICAL CENTER 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 1063675759 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:
Provider Other Organization Name Type Code:
6
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:
1063675759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6388808
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45264-8880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-301-5544
Provider Business Mailing Address Fax Number:
859-578-5975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4123 OLYMPIC BLVD.
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
ERLANGER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-5544
Provider Business Practice Location Address Fax Number:
859-578-5975
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEGRIS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BUSINESS HEALTH
Authorized Official Telephone Number:
859-301-5599

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , 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: G2000000497265 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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