Healthcare Provider Details

I. General information

NPI: 1306888284
Provider Name (Legal Business Name): JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 NEWBURG RD.
LOUISVILLE KY
40205-1803
US

IV. Provider business mailing address

250 E. LIBERTY SUITE 500
LOUISVILLE KY
40202-1536
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-3330
  • Fax:
Mailing address:
  • Phone: 502-587-4476
  • Fax: 502-587-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number100236
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number100236
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number100236
License Number StateKY

VIII. Authorized Official

Name: JOHN CLAGG
Title or Position: VP FINANCE
Credential:
Phone: 502-560-8357