Provider Demographics
NPI:1689831158
Name:DO NOT USE
Entity Type:Organization
Organization Name:DO NOT USE
Other - Org Name:BAPTISTWORX
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-238-2801
Mailing Address - Street 1:2600 STANLEY GAULT PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5129
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:
Practice Address - Street 1:11630 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2300
Practice Address - Country:US
Practice Address - Phone:502-267-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST COMMUNITY HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-21
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9536OtherMEDICARE GROUP