Organization
JEWISH HOSPITAL FPA
Active
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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