Provider Demographics
NPI:1689673717
Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Entity Type:Organization
Organization Name:JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC.
Other - Org Name:JEWISH HOSPITAL SHELBYVILLE
Other - Org Type:Doing Business As
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:502-587-4944
Practice Address - Street 1:727 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1660
Practice Address - Country:US
Practice Address - Phone:502-647-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100385282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200445070AMedicaid
KY5000028OtherUNITED HEALTHCARE
KY01022375Medicaid
KY1049843OtherPASSPORT
KY0492294OtherAETNA HMO
KY000000054800OtherANTHEM
KY006895400OtherUS DEPARTMENT OF LABOR
KY2432695000OtherPASSPORT ADVANTAGE
KY2432695000OtherPASSPORT ADVANTAGE
KY=========OtherCIGNA
KY=========009OtherCHAMPUS
KY000000054800OtherANTHEM