Provider Demographics
NPI:1538222500
Name:JENNIE STUART MEDICAL CENTER
Entity type:Organization
Organization Name:JENNIE STUART MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-887-0221
Mailing Address - Street 1:320 W 18TH ST
Mailing Address - Street 2:PO BOX 2400
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1965
Mailing Address - Country:US
Mailing Address - Phone:270-887-0118
Mailing Address - Fax:270-887-6822
Practice Address - Street 1:327 WEST 18TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240
Practice Address - Country:US
Practice Address - Phone:270-887-0118
Practice Address - Fax:270-887-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150072251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34002246Medicaid
KY000000054548OtherANTHEM BCBS
=========011OtherTRICARE
KY34002246Medicaid