Provider Demographics
NPI:1548248123
Name:METHODIST HEALTH, INC.
Entity type:Organization
Organization Name:METHODIST HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-827-7118
Mailing Address - Street 1:PO BOX 638706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8706
Mailing Address - Country:US
Mailing Address - Phone:270-827-7558
Mailing Address - Fax:270-827-7530
Practice Address - Street 1:1284 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-6236
Practice Address - Country:US
Practice Address - Phone:270-389-2323
Practice Address - Fax:270-389-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363A00000X, 363LF0000X
KY900221261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100114480Medicaid
KY65938227Medicaid
020427300OtherBLACK LUNG GROUP
KY65938227Medicaid
020427300OtherBLACK LUNG GROUP
KY7444Medicare ID - Type UnspecifiedGROUP