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DSH180035J ST ELIZABETH HEALTHCARE (Terminated)
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Main Details
Name
ST ELIZABETH HEALTHCARE
Subdivision Name
Vascular Imaging Center MOB
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180035J
Medicare Provider Number
180035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/24/2016
Last Recertification Date
8/20/2024
Termination Date
Termination Reason
4/1/2025
Change of covered entity type
Contacts
Authorizing Official
St. Elizabeth Healthcare
Lori Ritchey-Baldwin, CFO
(859) 655-1642
Primary Contact
St. Elizabeth Healthcare
Joe Thamann, Director of Reimbursement
(859) 655-1889
Addresses
Street Address
20 Medical Village Dr.
Suite 232
Edgewood, KY 41017
Billing Address
St. Elizabeth Healthcare
1 Medical Village Dr.
Edgewood, KY 41017
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/25/16 Previously participated 10/1/15 through 1/1/16, reinstated effective 7/1/16
05/25/2016
April 2025
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