=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689673717
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2005
-----------------------------------------------------
Last Update Date | 07/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 727 HOSPITAL DR
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40065-1660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-647-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2587
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40201-2587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-587-4099
-----------------------------------------------------
Fax | 502-587-4944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FINANCE
-----------------------------------------------------
Name | JOHN CLAGG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-560-8357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 100385
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------