Provider Demographics
NPI:1225059959
Name:ST ELIZABETH MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ST ELIZABETH MEDICAL CENTER INC
Other - Org Name:ST ELIZABETH HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUARK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:859-292-4245
Mailing Address - Street 1:401 E 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014
Mailing Address - Country:US
Mailing Address - Phone:859-292-4100
Mailing Address - Fax:
Practice Address - Street 1:401 E 20TH STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014
Practice Address - Country:US
Practice Address - Phone:859-292-4100
Practice Address - Fax:859-292-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150016251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34001594Medicaid
KY187046Medicare Oscar/Certification