=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356552863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 05/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 E LEWIS AND CLARK PKWY SUITE 101
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47129-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-283-9190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2587
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | STEPHEN J SCANNELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-587-4883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 060112391
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------