Provider Demographics
NPI: | 1518360296 |
---|---|
Name: | BAPTIST HEALTH MEDICAL GROUP INC |
Entity Type: | Organization |
Organization Name: | BAPTIST HEALTH MEDICAL GROUP INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VICE PRESIDENT REVENUE CYCLE |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | DANYEL |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | CLAY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 502-253-4911 |
Mailing Address - Street 1: | 5200 COMMERCE CROSSINGS DR FL FLOOR |
Mailing Address - Street 2: | |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40229-2182 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-253-4911 |
Mailing Address - Fax: | 502-489-5751 |
Practice Address - Street 1: | 4071 TATES CREEK CENTRE DR |
Practice Address - Street 2: | STE 202 |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40517 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-260-4390 |
Practice Address - Fax: | 859-260-4399 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-10-08 |
Last Update Date: | 2023-05-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YP2500X, 103T00000X, 1041C0700X, 2084P0800X, 2085P0229X, 213E00000X, 225100000X, 363A00000X, 363L00000X, 363A00000X, 363L00000X | ||
KY | 261Q00000X, 261QR1300X, 261QR1300X | |
KY | 900311 | 261QP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085P0229X | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | Group - Multi-Specialty |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | Group - Multi-Specialty |
No | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | K184931 | Medicare PIN | |
KY | 188935 | Medicare PIN | |
KY | 188940 | Medicare PIN |