ST ELIZABETH MEDICAL CENTER, INC

Provider Demographics

• NPI: 1740221795
• Name: ST ELIZABETH MEDICAL CENTER, INC
• Entity Type: Organization
• Organization Name: ST ELIZABETH MEDICAL CENTER, INC
• Other - Org Name: ST ELIZABETH FT. THOMAS
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CFO (INTERIM)
• Authorized Official - First Name: LORI
• Authorized Official - Last Name: RITCHEY-BALDWIN
• Authorized Official - Phone: 859-655-0109
• 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: 85 N GRAND AVE
• Practice Address - City: FORT THOMAS
• Practice Address - State: KY
• Practice Address - Zip Code: 41075
• Practice Address - Country: US
• Practice Address - Phone: 859-572-3100
• Practice Address - Fax: 859-578-5980
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-09
• Last Update Date: 2023-01-16

Provider Licenses

State	License ID	Taxonomies
KY		261QR0405X
KY	100059	282N00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	261QR0405X	Ambulatory Health Care Facilities	Clinic/Center	Rehabilitation, Substance Use Disorder

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	01010958	Medicaid
MO	013393707	Medicaid
MD	183235200	Medicaid
CO	52177254	Medicaid
IL	610486447001	Medicaid
AL	STL0001N	Medicaid
MO	01333707	Medicaid
VA	1740221795	Medicaid
CA	1740221795	Medicaid
KY	7100116580	Medicaid
MI	304727771	Medicaid
GA	00372281X	Medicaid
FL	097491900	Medicaid
IN	100276160A	Medicaid
MI	1740221795	Medicaid
MI	404727780	Medicaid
ME	431633600	Medicaid
KS	200005300C	Medicaid
NJ	4111508	Medicaid
AZ	858433	Medicaid
AL	121007	Medicaid
CA	XHSP32939	Medicaid
TN	0180001	Medicaid
NV	1740221795	Medicaid
NC	1800001	Medicaid
OH	2973804	Medicaid
CA	XHSP42939	Medicaid
NY	02534114	Medicaid
IA	0589184	Medicaid
ME	184510001	Medicaid
MI	304727771	Medicaid
KY	180001	Medicare Oscar/Certification