Basic Information
| Provider Information | |||||||||
| NPI: | 1083610315 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FRAZIER REHAB INSTITUTE MEDICAL CENTER EAST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2587 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402012587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025874099 | ||||||||
| FaxNumber: | 5025874944 | ||||||||
| Practice Location | |||||||||
| Address1: | 3920 DUTCHMANS LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022596600 | ||||||||
| FaxNumber: | 5022596605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 05/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | SPALDING | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5025827437 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 273Y00000X | 100806 | KY | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 000000180005 | 01 | KY | ANTHEM | OTHER |