Provider Demographics
NPI:1720086176
Name:SAINT JOSEPH HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:SAINT JOSEPH HEALTH SYSTEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE REALIZATION CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-313-4120
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:859-313-4120
Mailing Address - Fax:859-313-4120
Practice Address - Street 1:11203 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-7999
Practice Address - Country:US
Practice Address - Phone:859-313-4120
Practice Address - Fax:859-313-4120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOSEPH HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-11
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY611012503207P00000X
KY600056282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100106580Medicaid
KY8001Medicare PIN
KY5491Medicare PIN
KY5490Medicare PIN
KY8577Medicare PIN
KY181305Medicare Oscar/Certification
KY6649Medicare PIN