ST ELIZABETH MEDICAL CENTER, INC

Provider Demographics

• NPI: 1467492421
• Name: ST ELIZABETH MEDICAL CENTER, INC
• Entity Type: Organization
• Organization Name: ST ELIZABETH MEDICAL CENTER, INC
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: LORI
• Authorized Official - Last Name: RITCHEY-BALDWIN
• Authorized Official - Phone: 859-655-1642
• Mailing Address - Street 1: 1 MEDICAL VILLAGE DR
• Mailing Address - City: EDGEWOOD
• Mailing Address - State: KY
• Mailing Address - Zip Code: 41017-3403
• Mailing Address - Country: US
• Mailing Address - Phone: 859-655-1889
• Mailing Address - Fax: 859-578-5980
• Practice Address - Street 1: 1 MEDICAL VILLAGE DR
• Practice Address - City: EDGEWOOD
• Practice Address - State: KY
• Practice Address - Zip Code: 41017-3403
• Practice Address - Country: US
• Practice Address - Phone: 859-301-2000
• Practice Address - Fax: 859-578-5980
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-07
• Last Update Date: 2023-08-17

Provider Licenses

State	License ID	Taxonomies
KY	100272	282N00000X
KY	720405	335V00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	335V00000X	Suppliers	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Provider Identifiers

State	Identifier ID	ID Type	Issuer
LA	2153099	Medicaid
PA	0013019850004	Medicaid
SC	104683	Medicaid
AR	146655105	Medicaid
OR	500602914	Medicaid
KY	01013671	Medicaid
MO	016256604	Medicaid
WV	0170126000	Medicaid
IN	100034230A	Medicaid
	1061646	Other	PASSPORT
NE	614044585000	Medicaid
KS	100383870B	Medicaid
VA	9813268	Medicaid
GA	000105872A	Medicaid
NY	03080706	Medicaid
ID	1467492421	Medicaid
ME	1467492421	Medicaid
NJ	4112105	Medicaid
AL	120498	Medicaid
MI	1467492421	Medicaid
NC	1800035	Medicaid
AZ	769937	Medicaid
TN	0180035	Medicaid
TX	108804902	Medicaid
CA	1467492421	Medicaid
IA	1467492421	Medicaid
OK	200088280A	Medicaid
WA	3016169	Medicaid
OH	7645114	Medicaid
WI	81219200	Medicaid
FL	900049600	Medicaid
IL	=========001	Medicaid
LA	2153099	Medicaid