Provider Demographics
NPI:1790023216
Name:BAPTIST PHYSICIANS LEXINGTON, INC.
Entity Type:Organization
Organization Name:BAPTIST PHYSICIANS LEXINGTON, INC.
Other - Org Name:BAPTIST HEALTH KENTUCKY GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-260-4122
Mailing Address - Street 1:789 EASTERN BYP
Mailing Address - Street 2:SUITE 14
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2415
Mailing Address - Country:US
Mailing Address - Phone:859-625-0900
Mailing Address - Fax:859-625-0995
Practice Address - Street 1:4071 TATES CREEK CENTRE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3062
Practice Address - Country:US
Practice Address - Phone:859-625-0900
Practice Address - Fax:859-625-0995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST PHYSICIANS LEXINGTON, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-17
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33381207RG0100X
KY3006515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK002402Medicare PIN