=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558771063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF LOUISVILLE HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2014
-----------------------------------------------------
Last Update Date | 05/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 SOUTH JACKSON STREET
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-562-3000
-----------------------------------------------------
Fax | 502-562-4431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 S JACKSON ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-562-3000
-----------------------------------------------------
Fax | 502-562-4431
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING
-----------------------------------------------------
Name | MS. ELEANOR BATES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-390-1815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 3710P
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------