Provider Demographics
NPI:1790953768
Name:WESTERN BAPTIST MEDICAL VENTURES, INC.
Entity Type:Organization
Organization Name:WESTERN BAPTIST MEDICAL VENTURES, INC.
Other - Org Name:EAR, NOSE & THROAT OF W KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN INTEGRATION
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-575-8362
Mailing Address - Street 1:PO BOX 7309
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7309
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0834
Practice Address - Street 1:2601 KENTUCKY AVE STE 201
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3825
Practice Address - Country:US
Practice Address - Phone:502-575-0079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN BAPTIST MEDICAL VENTURES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDF7549Medicare PIN
KY00211Medicare PIN