Healthcare Provider Details

I. General information

NPI: 1003851981
Provider Name (Legal Business Name): JEWISH HOSPITAL & ST MARYS HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 COMMERCE CROSSINGS DR STE 130
LOUISVILLE KY
40229-3128
US

IV. Provider business mailing address

PO BOX 950209
LOUISVILLE KY
40295-0209
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-7677
  • Fax: 502-585-7678
Mailing address:
  • Phone: 502-585-7677
  • Fax: 502-585-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number64000175A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberNRP.022399200-03
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberP06548
License Number StateKY

VIII. Authorized Official

Name: MICHELLE WOOSLEY
Title or Position: DIRECTOR OF OPERATIONS
Credential: PHARMD.
Phone: 502-585-7677