Healthcare Provider Details

I. General information

NPI: 1700226271
Provider Name (Legal Business Name): SAINT JOSEPH MEDICAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 W 5TH ST STE 201
LONDON KY
40741-1688
US

IV. Provider business mailing address

PO BOX 73652
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 606-330-2377
  • Fax: 606-330-2369
Mailing address:
  • Phone: 859-313-2758
  • Fax: 859-276-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CARMEL JONES
Title or Position: COO/PRESIDENT
Credential:
Phone: 606-309-5506