Basic Information
| Provider Information | |||||||||
| NPI: | 1003851981 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEWISH HOSPITAL & ST MARYS HEALTHCARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AMERIMED, INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950209 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025857677 | ||||||||
| FaxNumber: | 5025857678 | ||||||||
| Practice Location | |||||||||
| Address1: | 5111 COMMERCE CROSSINGS DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402293128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025857677 | ||||||||
| FaxNumber: | 5025857678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 07/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | WOOSLEY | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5025857677 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARMD. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336S0011X | P06548 | KY | N | Suppliers | Pharmacy | Specialty Pharmacy | 3336H0001X | NRP.022399200-03 | OH | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 3336H0001X | 64000175A | IN | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 54001326 | 05 | KY | MEDICAID | 200299050A | 05 | IN | MEDICAID | 2033005 | 01 | PK | OTHER | 90001561 | 05 | KY | MEDICAID |