ST ELIZABETH MEDICAL CENTER, INC

Provider Demographics

• NPI: 1932187937
• Name: ST ELIZABETH MEDICAL CENTER, INC
• Entity Type: Organization
• Organization Name: ST ELIZABETH MEDICAL CENTER, INC
• Other - Org Name: ST. ELIZABETH HEALTHCARE
• Other - Org Type: Doing Business As
• 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: 1360 DOLWICK DRIVE
• Mailing Address - City: ERLANGER
• Mailing Address - State: KY
• Mailing Address - Zip Code: 41018
• Mailing Address - Country: US
• Mailing Address - Phone: 859-344-5555
• Mailing Address - Fax: 859-344-5552
• Practice Address - Street 1: 1360 DOLWICK DRIVE
• Practice Address - City: ERLANGER
• Practice Address - State: KY
• Practice Address - Zip Code: 41018
• Practice Address - Country: US
• Practice Address - Phone: 859-344-5555
• Practice Address - Fax: 859-344-5552
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-01-09
• Last Update Date: 2019-10-15

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
Yes	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	174400000X	Other Service Providers	Specialist		Group - Multi-Specialty
No	207ZP0101X	Allopathic & Osteopathic Physicians	Pathology	Anatomic Pathology	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	207RS0012X	Allopathic & Osteopathic Physicians	Internal Medicine	Sleep Medicine	Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	207RP1001X	Allopathic & Osteopathic Physicians	Internal Medicine	Pulmonary Disease	Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	200288340	Medicaid
KY	7100074550	Medicaid
OH	2291238	Medicaid
KY	89900286	Medicaid
KY	78901451	Medicaid
KY	82900135	Medicaid
KY	50900265	Medicaid
KY	65921918	Medicaid
KY	65935785	Medicaid
KY	7100061190	Medicaid
	CH5799	Medicare PIN
KY	6550	Medicare PIN
IN	200288340	Medicaid
KY	7100074550	Medicaid
KY	65921918	Medicaid