Provider Demographics
NPI:1790915585
Name:BAPTIST HEALTHCARE AFFILIATES, INC
Entity Type:Organization
Organization Name:BAPTIST HEALTHCARE AFFILIATES, INC
Other - Org Name:BAPTIST NORTHEAST HOSPITALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-222-3329
Mailing Address - Street 1:1025 NEW MOODY LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9154
Mailing Address - Country:US
Mailing Address - Phone:502-222-3894
Mailing Address - Fax:
Practice Address - Street 1:1025 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9154
Practice Address - Country:US
Practice Address - Phone:502-222-3894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50026499OtherPASSPORT
KY7100104160Medicaid
KY50026499OtherPASSPORT
KY=========004OtherTRICARE
KYDR4870Medicare PIN