1063777316 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 1063777316 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 INTERNAL MEDICINE AND ENDOCRINOLOGY AT BEAUMONT
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:
1063777316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3084 LAKECREST CIRCLE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-219-6440
Provider Business Mailing Address Fax Number:
859-219-6449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3084 LAKECREST CIRCLE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-219-6440
Provider Business Practice Location Address Fax Number:
859-219-6449
Provider Enumeration Date:
07/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MOBLEY
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
859-260-4122

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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