1164795233 NPI number — BAPTIST FAMILY MEDICINE AT TATES CREEK

Table of content: (NPI 1164795233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164795233 NPI number — BAPTIST FAMILY MEDICINE AT TATES CREEK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST FAMILY MEDICINE AT TATES CREEK
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:
1164795233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4071 TATES CREEK CENTRE DRIVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-273-3888
Provider Business Mailing Address Fax Number:
859-971-4601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4071 TATES CREEK CENTRE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-273-3888
Provider Business Practice Location Address Fax Number:
859-971-4601
Provider Enumeration Date:
02/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FLECKINSTEIN
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE DIRECTOR
Authorized Official Telephone Number:
859-971-4633

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 3002500 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7100076480 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com