Provider Demographics
NPI:1326142498
Name:ST ELIZABETH MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST ELIZABETH MEDICAL CENTER, INC
Other - Org Name:ST ELIZABETH DEARBORN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCHEY-BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-655-1642
Mailing Address - Street 1:600 WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-2751
Mailing Address - Country:US
Mailing Address - Phone:812-537-1010
Mailing Address - Fax:
Practice Address - Street 1:600 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2751
Practice Address - Country:US
Practice Address - Phone:812-537-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207R00000X, 207RC0000X, 207RP1001X, 208100000X, 2084N0400X, 2085R0202X, 208600000X
IN060050771282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000329743OtherANTHEM REF LAB BILLING
OH2061094Medicaid
35600659501OtherOHIO WORKERS COMP 1500
IN100268530AMedicaid
000000002936OtherANTHEM UB BILLING
IN200017350AMedicaid
35600659500OtherOHIO WORKERS COMP UB
000000076353OtherANTHEM PROFEE BILLING
OH2061094Medicaid
=========00OtherOHIO WORKERS COMP UB