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DSH180035AL ST ELIZABETH HEALTHCARE (Terminated)
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Main Details
Name
ST ELIZABETH HEALTHCARE
Subdivision Name
Edgewood Burlington PT - Edgewood Burlington PT
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH180035AL
Medicare Provider Number
180035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/19/2021
Last Recertification Date
8/19/2024
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
5874 Veterans Way
Burlington, KY 41005
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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April 2025
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