MEDICARE: JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center
2	273Y00000X	Rehabilitation Hospital Unit	100657	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000063938	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1831195635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2587
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-2587
Country	:	US
Telephone Number	:	502-587-4099
Fax Number	:	502-587-4944

Provider Business Practice Location Address
First Line	:	3430 NEWBURG RD
Second Line	:	STE 111A
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2497
Country	:	US
Telephone Number	:	502-451-6886
Fax Number	:	502-458-2158

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CATHERINE L. SPALDING
Credential	:
Telephone Number	:	502-582-7437

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	05/18/2017

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