1073886149 NPI number — BAPTIST PHYSICIANS LEXINGTON, INC

Table of content: (NPI 1073886149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073886149 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:
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:
1073886149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 BEVINS LN
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40324-6120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-868-0622
Provider Business Mailing Address Fax Number:
502-868-9097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 BEVINS LN
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-6120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-868-0622
Provider Business Practice Location Address Fax Number:
502-868-9097
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: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100150960 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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