Provider Demographics
NPI:1992937791
Name:SAINT JOSEPH MEDICAL FOUNDATION, INC
Entity type:Organization
Organization Name:SAINT JOSEPH MEDICAL FOUNDATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KANDI
Authorized Official - Middle Name:R
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-330-3404
Mailing Address - Street 1:PO BOX 73652
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:606-330-3404
Mailing Address - Fax:606-330-3100
Practice Address - Street 1:4359 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:STE 205
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8000
Practice Address - Country:US
Practice Address - Phone:502-350-5492
Practice Address - Fax:502-350-5451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOSEPH MEDICAL FOUNDATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-13
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty