Provider Demographics
NPI:1689695322
Name:ST ELIZABETH MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:ST ELIZABETH MEDICAL CENTER, INC
Other - Org Name:ST ELIZABETH HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO (INTERIM)
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:859-655-0109
Mailing Address - Street 1:1 MEDICAL VILLAGE DR
Mailing Address - Street 2:
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 1:483 SOUTH LOOP RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-301-4600
Practice Address - Fax:859-655-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY400016251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY44059012Medicaid
KY44059012Medicaid