1720573934 NPI number — BAPTIST HEALTH MEDICAL GROUP 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 1720573934 NPI number — BAPTIST HEALTH MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST HEALTH MEDICAL GROUP 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:
RURAL HEALTH CLINIC CORBIN
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:
1720573934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 COMMERCE CROSSINGS DR FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40229-2182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-526-8131
Provider Business Mailing Address Fax Number:
606-528-8661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 FUTURE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-8988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-0305
Provider Business Practice Location Address Fax Number:
606-523-4368
Provider Enumeration Date:
06/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CLAY
Authorized Official First Name:
DANYEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR, REVENUE CYCLE
Authorized Official Telephone Number:
502-253-4911

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  900311 , 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: 18-8975 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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