Organization
ST JOSEPH HOSPITAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (AO)
(502) 596-6063
Entity
Organization
Contact information
Practice address
415 6TH STREET, PHYSICIAN SERVICES, LEWISTON, ID 83501-8350
(208) 750-7462
Mailing address
680 S 4TH ST, LOUISVILLE, KY 40202-2407
(502) 596-6063
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205368404
—
ID
Enumeration date
03/28/2017
Last updated
06/25/2025
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