Provider Demographics
NPI:1609810944
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 ELIZABETHTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-540-3888
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:502-587-4904
Practice Address - Street 1:708 WESTPORT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2866
Practice Address - Country:US
Practice Address - Phone:270-360-8094
Practice Address - Fax:270-769-3260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY186646OtherMEDICARE