Provider Demographics
NPI:1568699478
Name:WESTERN BAPTIST MEDICAL VENTURES, INC
Entity Type:Organization
Organization Name:WESTERN BAPTIST MEDICAL VENTURES, INC
Other - Org Name:NEUROLOGY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL EXECUTIVE DIR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-415-7646
Mailing Address - Street 1:PO BOX 7309
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7309
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0834
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3814
Practice Address - Country:US
Practice Address - Phone:270-415-4800
Practice Address - Fax:270-415-4801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN BAPTIST MEDICAL VENTURES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-18
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY445382084N0400X
KY3006220364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00211Medicare PIN
KYDF7549Medicare PIN