Organization
JEWISH HOSPITAL FPA
Active
Other names
JEWISH HOSPITAL FPA
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
7612 SHEPHERDSVILLE RD, LOUISVILLE, KY 40219-2963
(502) 968-6226
(502) 966-5562
Mailing address
7612 SHEPHERDSVILLE RD, LOUISVILLE, KY 40219-2963
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
18030
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1826796
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
64480300
—
KY
Enumeration date
10/24/2006
Last updated
08/22/2020
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