NPIMap

Organization Active NPI

St. Elizabeth Medical Center, Inc.

  • Specialty Pharmacy
  • Edgewood, KY
National Provider Identifier
1366084337
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
Legal business name
ST. ELIZABETH MEDICAL CENTER, INC.
Practice address
850 Thomas More Parkway
Edgewood, KY 41017
Phone
(859) 301-4525
NPI assigned
Oct 11, 2019
Last updated
Oct 11, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. ELIZABETH MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary Blank
Title
Evp/Coo
Phone
(859) 301-2370

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Mail Order Pharmacy 3336M0002X
Specialty Pharmacy 3336S0011X Primary

Addresses

Primary practice location

850 Thomas More Parkway
Edgewood, KY 41017

Mailing address

20 Medical Village Drive
Edgewood, KY 41017
Phone (859) 301-9025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200511000676 KY DME Supplier - Pharmacy 0648174623 Practice locations: Edgewood, KY

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory
Tax ID family
St Elizabeth Hosp26 organizations share this tax ID, including this one
Part of
St Elizabeth Hosp

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. Elizabeth Dearborn HospitalLawrenceburg, IN, CCN 150086 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2020
St. Elizabeth Ft. Thomas - SNFFort Thomas, KY, CCN 185328 Skilled nursing facility Adp of the SNF Dec 31, 2024
St Elizabeth HealthcareEdgewood, KY, CCN 185394 Skilled nursing facility Adp of the SNF Jan 16, 2019
St. Elizabeth Home CareFlorence, KY, CCN 187075 Home health agency 5% Or Greater Direct Ownership Interest (50%) Dec 3, 2007
St Elizabeth Home Care ServicesLawrenceburg, IN, CCN 157055 Home health agency 5% Or Greater Direct Ownership Interest (50%) Oct 9, 2020

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1366084337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 MEDICAL VILLAGE DRIVE",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "41017",
            "telephone_number": "859-301-9025",
            "fax_number": "859-301-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 THOMAS MORE PARKWAY",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "41017",
            "telephone_number": "859-301-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ELIZABETH MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. ELIZABETH MEDICAL CENTER, INC.",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "EVP/COO",
        "authorized_official_telephone_number": "859-301-2370"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.