Healthcare Provider Details

I. General information

NPI: 1811126964
Provider Name (Legal Business Name): SAINT JOSEPH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE C-100
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

PO BOX 73652
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-4960
  • Fax: 859-277-7372
Mailing address:
  • Phone: 606-330-3404
  • Fax: 606-330-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN MEEKS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 859-313-2758