Provider Demographics
NPI:1407049992
Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Entity Type:Organization
Organization Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Other - Org Name:VNA NAZARETH HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCANNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-587-4883
Mailing Address - Street 1:539 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2535
Mailing Address - Country:US
Mailing Address - Phone:502-333-8190
Mailing Address - Fax:
Practice Address - Street 1:5000 COMMERCE CROSSINGS DR
Practice Address - Street 2:SUITE 100A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2119
Practice Address - Country:US
Practice Address - Phone:502-333-8190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP065483336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9375701OtherMEDICARE