Provider Demographics
NPI:1093088163
Name:BAPTIST PHYSICIANS LEXINGTON, INC
Entity Type:Organization
Organization Name:BAPTIST PHYSICIANS LEXINGTON, INC
Other - Org Name:BAPTIST NEUROLOGY CENTER - LEXINGTON
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 1:799 E BRANNON RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-6038
Mailing Address - Country:US
Mailing Address - Phone:859-260-4330
Mailing Address - Fax:859-260-4334
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2518
Practice Address - Country:US
Practice Address - Phone:859-260-4330
Practice Address - Fax:859-260-4334
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:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100073410Medicaid
KYK002402Medicare PIN