Provider Demographics
NPI:1326311499
Name:BAPTIST PHYSICIANS LEXINGTON, INC
Entity Type:Organization
Organization Name:BAPTIST PHYSICIANS LEXINGTON, INC
Other - Org Name:BAPTIST EXPRESS CARE
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 1:4071 TATES CREEK CENTRE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3062
Mailing Address - Country:US
Mailing Address - Phone:859-260-4385
Mailing Address - Fax:859-260-4386
Practice Address - Street 1:4071 TATES CREEK CENTRE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3062
Practice Address - Country:US
Practice Address - Phone:859-260-4385
Practice Address - Fax:859-260-4386
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
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100100380Medicaid
KY7100100380Medicaid