Healthcare Provider Details

I. General information

NPI: 1801182654
Provider Name (Legal Business Name): SAINT JOSEPH MEDICAL FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EAGLE CREEK DR SUITE 202
LEXINGTON KY
40509-2121
US

IV. Provider business mailing address

PO BOX 73652
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-0022
  • Fax: 859-263-4666
Mailing address:
  • Phone: 859-276-6611
  • Fax: 859-276-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. CARMEL JONES
Title or Position: COO/VP FINANCE
Credential:
Phone: 606-330-6015