Provider Demographics
NPI:1811003270
Name:BAPTIST PHYSICIANS LEXINGTON, INC
Entity Type:Organization
Organization Name:BAPTIST PHYSICIANS LEXINGTON, INC
Other - Org Name:BAPTIST NEUROLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-260-6104
Mailing Address - Street 1:1800 NICHOLASVILLE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1443
Mailing Address - Country:US
Mailing Address - Phone:859-278-5452
Mailing Address - Fax:859-275-1153
Practice Address - Street 1:1800 NICHOLASVILLE RD
Practice Address - Street 2:STE 301
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1443
Practice Address - Country:US
Practice Address - Phone:859-278-5452
Practice Address - Fax:859-275-1153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST PHYSICIANS LEXINGTON, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64174345Medicaid
000000047429OtherBLUE CROSS BLUE SHIELD
KY65945578Medicaid
KY00574Medicare PIN
KY64174345Medicaid
000000047429OtherBLUE CROSS BLUE SHIELD