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General NPI Number Information
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NPI Number | 1760566392
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Entity Type | Organization
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Legal Business Name | JEWISH HOSPITAL FPA
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7612 SHEPHERDSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40219-2963
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Country | US
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Telephone | 502-968-6226
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Fax | 502-966-5562
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Provider Business Mailing Address
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Address Line | 7612 SHEPHERDSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40219-2963
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGED CARE SPECIALIST
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Name | DIRENDIA SHACKELFORD
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Credential |
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Telephone | 800-654-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 18030
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License Number State | KY
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