NPIViewer - Provider NPI 1154365062

NPI:	1154365062
Name:	ST ELIZABETH MEDICAL CENTER, INC
Entity type:	Organization
Organization Name:	ST ELIZABETH MEDICAL CENTER, INC
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	CFO (INTERIM)
Authorized Official - Prefix:
Authorized Official - First Name:	LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:	RITCHEY-BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	859-655-0109
Mailing Address - Street 1:	1 MEDICAL VILLAGE DR
Mailing Address - Street 2:
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:	4900 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:	FLORENCE
Practice Address - State:	KY
Practice Address - Zip Code:	41042
Practice Address - Country:	US
Practice Address - Phone:	859-212-5200
Practice Address - Fax:	859-578-5980
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-06-15
Last Update Date:	2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:

State	License ID	Taxonomies
KY	100273	261QR0405X, 282N00000X

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

State	Identifier ID	ID Type
CA	1154365062	Medicaid
ME	431633600	Medicaid
NY	01754530	Medicaid
KS	200005300A	Medicaid
KY	7100116650	Medicaid
ID	806346000	Medicaid
GA	00504765X	Medicaid
AZ	114934	Medicaid
AR	123999105	Medicaid
LA	1766275	Medicaid
MI	304607380	Medicaid
AL	SLH0045N	Medicaid
MT	0413355	Medicaid
AL	117986	Medicaid
NC	1800045	Medicaid
WV	3810017096	Medicaid
CA	XHSP33521	Medicaid
KY	01022193	Medicaid
MO	013436902	Medicaid
TN	0180045	Medicaid
IN	100276160A	Medicaid
KS	100383870D	Medicaid
OK	200049760A	Medicaid
MI	1154365062	Medicaid
MI	404607399	Medicaid
CO	76381366	Medicaid
FL	912682100	Medicaid
OH	2914485	Medicaid
MS	02820591	Medicaid
IN	200969580A	Medicaid
IL	610486447002	Medicaid
CA	XHSP43521	Medicaid
CA	XHSP33521	Medicaid
ID	806346000	Medicaid