1174780647 NPI number — ST ELIZABETH MEDICAL CENTER, INC

Table of content: (NPI 1174780647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174780647 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:
1174780647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 E 20TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-655-1821
Provider Business Mailing Address Fax Number:
859-655-1773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 BARNES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-824-8240
Provider Business Practice Location Address Fax Number:
859-655-1773
Provider Enumeration Date:
05/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VANLANINGHAM
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO & TREASURER
Authorized Official Telephone Number:
859-655-1642

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0512774 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000063670 . This is a "ANTHEM REF LAB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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