Basic Information
| Provider Information | |||||||||
| NPI: | 1316296676 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. ELIZABETH HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593012000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 236 WENDEL H FORD BLVD | ||||||||
| Address2: | |||||||||
| City: | ERLANGER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410181272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598178148 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2012 | ||||||||
| LastUpdateDate: | 09/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | DAVIES | ||||||||
| AuthorizedOfficialFirstName: | EVAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR BUSINESS HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 8593019053 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 3007363 | KY | Y | Hospitals | General Acute Care Hospital |
No ID Information.