Provider Demographics
NPI:1689229189
Name:BAPTIST HEALTH MEDICAL GROUP INC
Entity Type:Organization
Organization Name:BAPTIST HEALTH MEDICAL GROUP INC
Other - Org Name:EDDYVILLE FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT REVENUE CYCLE
Authorized Official - Prefix:
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 3
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:502-489-5752
Practice Address - Street 1:627 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038-7386
Practice Address - Country:US
Practice Address - Phone:270-388-5454
Practice Address - Fax:270-388-5452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health