Healthcare Provider Details

I. General information

NPI: 1467492421
Provider Name (Legal Business Name): ST ELIZABETH MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2000
  • Fax: 859-578-5980
Mailing address:
  • Phone: 859-655-1889
  • Fax: 859-578-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number100272
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number720405
License Number StateKY

VIII. Authorized Official

Name: LORI RITCHEY-BALDWIN
Title or Position: CFO
Credential:
Phone: 859-655-1642