Provider Demographics
NPI:1073886149
Name:BAPTIST PHYSICIANS LEXINGTON, INC
Entity Type:Organization
Organization Name:BAPTIST PHYSICIANS LEXINGTON, INC
Other - Org Name:BAPTIST FAMILY PHYSICIANS OF SCOTT COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-260-6104
Mailing Address - Street 1:210 BEVINS LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6120
Mailing Address - Country:US
Mailing Address - Phone:502-868-0622
Mailing Address - Fax:502-868-9097
Practice Address - Street 1:210 BEVINS LN
Practice Address - Street 2:SUITE C
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6120
Practice Address - Country:US
Practice Address - Phone:502-868-0622
Practice Address - Fax:502-868-9097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST PHYSICIANS LEXINGTON, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100150960Medicaid
KY7100150960Medicaid