Provider Demographics
NPI:1891924320
Name:SAINT JOSEPH HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:SAINT JOSEPH HEALTH SYSTEM INC
Other - Org Name:SETON FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-285-6602
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-0910
Mailing Address - Country:US
Mailing Address - Phone:606-285-3690
Mailing Address - Fax:606-285-6769
Practice Address - Street 1:11203 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-285-3690
Practice Address - Fax:606-285-6769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOSEPH HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-06
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35000843Medicaid