Healthcare Provider Details

I. General information

NPI: 1144523911
Provider Name (Legal Business Name): SAINT JOSEPH MEDICAL FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ESTILL ST
BEREA KY
40403-1742
US

IV. Provider business mailing address

PO BOX 73652
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-3151
  • Fax:
Mailing address:
  • Phone: 859-313-2758
  • Fax: 859-276-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1195
License Number StateKY

VIII. Authorized Official

Name: MS. CARMEL JONES
Title or Position: VP AND CHIEF OPERATING OFFICER
Credential:
Phone: 606-309-5506