Provider Demographics
| NPI: | 1235139312 |
|---|---|
| Name: | JENNIE STUART MEDICAL CENTER INC |
| Entity Type: | Organization |
| Organization Name: | JENNIE STUART MEDICAL CENTER INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT / CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | ERIC |
| Authorized Official - Middle Name: | ALAN |
| Authorized Official - Last Name: | LEE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 270-887-0100 |
| Mailing Address - Street 1: | PO BOX 2400 |
| Mailing Address - Street 2: | 320 W 18TH ST |
| Mailing Address - City: | HOPKINSVILLE |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 42241-2400 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 270-887-0100 |
| Mailing Address - Fax: | 270-887-9266 |
| Practice Address - Street 1: | 320 W 18TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | HOPKINSVILLE |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 42240-1965 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 270-887-0100 |
| Practice Address - Fax: | 270-887-9266 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-07-29 |
| Last Update Date: | 2023-02-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103TC0700X, 207L00000X, 2084N0400X, 363L00000X, 363LF0000X, 363LN0000X, 364SF0001X, 367500000X | ||
| KY | 6593432500 | 207Q00000X |
| KY | 65939332 | 207RC0000X |
| KY | 65941742 | 208600000X |
| KY | 78903788 | 2086S0122X |
| KY | 7100104890 | 208M00000X |
| KY | 100068 | 282N00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LN0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | Group - Multi-Specialty |
| No | 364SF0001X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | Group - Multi-Specialty |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 1066495 | Medicaid | |
| KY | 01010859 | Medicaid | |
| KY | 000000212362 | Other | BLUE CROSS PHYSICIAN |
| KY | 7100104890 | Medicaid | |
| KY | 78903788 | Medicaid | |
| KY | 039724400 | Other | KENTUCKY BLACK LUNG |
| KY | 65939332 | Medicaid | |
| KY | 000000054549 | Other | BLUE CROSS PROVIDER |
| KY | 6593432500 | Medicaid | |
| KY | 65941742 | Medicaid | |
| KY | 163067200 | Other | US DEPT OF LABOR |
| KY | 039724400 | Other | KENTUCKY BLACK LUNG |
| KY | 180051 | Medicare Oscar/Certification |
