Provider Demographics
NPI:1174780647
Name:ST ELIZABETH MEDICAL CENTER, INC
Entity type:Organization
Organization Name:ST ELIZABETH MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANLANINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-655-1642
Mailing Address - Street 1:401 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014
Mailing Address - Country:US
Mailing Address - Phone:859-655-1821
Mailing Address - Fax:859-655-1773
Practice Address - Street 1:238 BARNES RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097
Practice Address - Country:US
Practice Address - Phone:859-824-8240
Practice Address - Fax:859-655-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0512774OtherAETNA
KY000000063670OtherANTHEM REF LAB