Provider Demographics
NPI:1588601991
Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Entity type:Organization
Organization Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-560-8357
Mailing Address - Street 1:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-2587
Mailing Address - Country:US
Mailing Address - Phone:502-587-4099
Mailing Address - Fax:
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-361-6000
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:2006-06-02
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100254282N00000X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY180040Medicare ID - Type Unspecified