Basic Information
| Provider Information | |||||||||
| NPI: | 1700226271 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT JOSEPH MEDICAL FOUNDATION, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PREMIER FAMILY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73652 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593132758 | ||||||||
| FaxNumber: | 8592765539 | ||||||||
| Practice Location | |||||||||
| Address1: | 1406 W 5TH ST | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407411688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063302377 | ||||||||
| FaxNumber: | 6063302369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2013 | ||||||||
| LastUpdateDate: | 06/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CARMEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6063095506 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.