Provider Demographics
NPI:1063675759
Name:ST ELIZABETH MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ST ELIZABETH MEDICAL CENTER INC
Other - Org Name:ST ELIZABETH BUSINESS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-301-5599
Mailing Address - Street 1:PO BOX 6388808
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-8880
Mailing Address - Country:US
Mailing Address - Phone:859-301-5544
Mailing Address - Fax:859-578-5975
Practice Address - Street 1:4123 OLYMPIC BLVD.
Practice Address - Street 2:SUITE 150
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018
Practice Address - Country:US
Practice Address - Phone:859-301-5544
Practice Address - Fax:859-578-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG2000000497265OtherANTHEM