1033405311 NPI number — BAPTIST MEDICAL MANAGEMENT SERVICES INC

Table of content: (NPI 1033405311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033405311 NPI number — BAPTIST MEDICAL MANAGEMENT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST MEDICAL MANAGEMENT SERVICES 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:
Provider Other Organization Name Type Code:
6
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:
1033405311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-1644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-825-7200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CLINIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-4989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-707-4262
Provider Business Practice Location Address Fax Number:
270-707-4280
Provider Enumeration Date:
06/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WHITAKER
Authorized Official First Name:
E
Authorized Official Middle Name:
BERTON
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
270-825-5979

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100192750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100149860 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com