Provider Demographics
NPI:1477898336
Name:BAPTIST PHYSICIANS LEXINGTON, INC.
Entity Type:Organization
Organization Name:BAPTIST PHYSICIANS LEXINGTON, INC.
Other - Org Name:BAPTIST CARDIOLOGY SOMERSET - THANNOLI DRIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-260-4122
Mailing Address - Street 1:55 THANNOLI DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2861
Mailing Address - Country:US
Mailing Address - Phone:606-677-0854
Mailing Address - Fax:606-677-9311
Practice Address - Street 1:55 THANNOLI DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2861
Practice Address - Country:US
Practice Address - Phone:606-677-0854
Practice Address - Fax:606-677-9311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST PHYSICIANS LEXINGTON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-04
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31681207RC0000X
KY3004692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK002402Medicare PIN