Provider Demographics
NPI:1225016801
Name:METHODIST HEALTH, INC.
Entity Type:Organization
Organization Name:METHODIST HEALTH, INC.
Other - Org Name:DEACONESS HENDERSON ANESTHESIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-827-7118
Mailing Address - Street 1:PO BOX 638704
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8704
Mailing Address - Country:US
Mailing Address - Phone:270-827-7468
Mailing Address - Fax:270-831-7804
Practice Address - Street 1:1305 NORTH ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420
Practice Address - Country:US
Practice Address - Phone:270-827-7700
Practice Address - Fax:270-827-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74900481Medicaid
KY000000223701OtherANTHEM GROUP/MD'S
KY000000337068OtherANTHEM GROUP/CRNA'S
KY65935546Medicaid
KY74900481Medicaid
KY0140Medicare PIN