1073678330 NPI number — JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.

Table of content: (NPI 1073678330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073678330 NPI number — JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JEWISH HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073678330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2587
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40201-2587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-587-4011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ABRAHAM FLEXNER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-4011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLAGG
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
502-560-8357

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  100215 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0485429 . This is a "AETNA HMO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100275640A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01022367 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000054799 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 304657327 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000032104 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1049530 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5000027 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2432563000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 006895400 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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