Organization
KINDRED HOSPITAL LOUISVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (AO)
(502) 596-6063
Entity
Organization
Contact information
Practice address
1313 SAINT ANTHONY PL, LOUISVILLE, KY 40204-1740
(502) 627-1100
Mailing address
680 S 4TH ST # KH-3, LOUISVILLE, KY 40202-2407
(502) 596-6063
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000355124
ANTHEM BCBS
—
01
—
447236000
PASSPORT ADVANTAGE
—
01
—
50005946
PASSPORT
—
05
—
65902959
—
KY
01
—
DB2622
RAILROAD MEDICARE
—
Enumeration date
02/12/2007
Last updated
06/23/2025
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