=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134553902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAINT JOSEPH HEALTH SYSTEM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2013
-----------------------------------------------------
Last Update Date | 08/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1406 W 5TH ST STE 1
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-1688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-877-4579
-----------------------------------------------------
Fax | 606-330-6711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1406 W 5TH ST STE 1
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-1688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-877-4579
-----------------------------------------------------
Fax | 606-330-6711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | CHRISTY SPITSER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-877-4579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------