Provider Demographics
NPI:1710115621
Name:BAPTIST HEALTH RICHMOND, INC.
Entity Type:Organization
Organization Name:BAPTIST HEALTH RICHMOND, INC.
Other - Org Name:PATTIE A CLAY INTERNAL MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP SUPPORT SVC.
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-625-3795
Mailing Address - Street 1:P.O. BOX 34166
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588-4166
Mailing Address - Country:US
Mailing Address - Phone:859-624-6560
Mailing Address - Fax:859-624-6569
Practice Address - Street 1:793 EASTERN BYPASS
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2440
Practice Address - Country:US
Practice Address - Phone:859-624-6560
Practice Address - Fax:859-624-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100091190Medicaid
KY01092Medicare PIN