Healthcare Provider Details

I. General information

NPI: 1144511866
Provider Name (Legal Business Name): SAINT JOSEPH MEDICAL FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LONDON MOUNTAIN VIEW DR
LONDON KY
40741-6601
US

IV. Provider business mailing address

PO BOX 73652
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-0770
  • Fax: 606-864-1461
Mailing address:
  • Phone: 859-313-2758
  • Fax: 859-276-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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