Provider Demographics
NPI:1497751713
Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Entity Type:Organization
Organization Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Other - Org Name:FRAZIER REHAB INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE & REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:BIBELHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-587-4773
Mailing Address - Street 1:250 E. LIBERTY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1536
Mailing Address - Country:US
Mailing Address - Phone:502-587-4099
Mailing Address - Fax:502-587-4904
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-582-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-22
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100244273Y00000X
KY100236282N00000X, 283Q00000X, 282N00000X, 283Q00000X
283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No273Y00000XHospital UnitsRehabilitation Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000065198OtherANTHEM
KY01022367Medicaid
KY1048800OtherPASSPORT
KY847339OtherBLACK LUNG
IN100276080AMedicaid
KY0604350OtherAETNA HMO
KY104379600OtherUS DEPARTMENT OF LABOR
KY93000107Medicaid
KY5000022OtherUNITED HEALTHCARE
KY2432222000OtherPASSPORT ADVANTAGE
KY93000107Medicaid
KY0604350OtherAETNA HMO
KY=========HOtherHUMANA
IN100276080AMedicaid