Provider Demographics
NPI:1982955290
Name:SAINT JOSEPH HEALTH SYSTEM INC.
Entity Type:Organization
Organization Name:SAINT JOSEPH HEALTH SYSTEM INC.
Other - Org Name:SAINT JOSEPH BEREA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-313-1694
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:305 ESTILL ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1742
Practice Address - Country:US
Practice Address - Phone:859-986-2343
Practice Address - Fax:859-986-2344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOSEPH HEALTH SYSTEM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-26
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18-3473261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183473Medicare PIN