1093088163 NPI number — BAPTIST PHYSICIANS LEXINGTON, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093088163 NPI number — BAPTIST PHYSICIANS LEXINGTON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST PHYSICIANS LEXINGTON, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BAPTIST NEUROLOGY CENTER - LEXINGTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093088163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
799 E BRANNON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NICHOLASVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40356-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-260-4330
Provider Business Mailing Address Fax Number:
859-260-4334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 NICHOLASVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-260-4330
Provider Business Practice Location Address Fax Number:
859-260-4334
Provider Enumeration Date:
02/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SISSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-260-6104

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100073410 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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