Provider Demographics
NPI:1891062204
Name:BAPTIST HEALTH RICHMOND INC
Entity Type:Organization
Organization Name:BAPTIST HEALTH RICHMOND INC
Other - Org Name:ADVANCED ORTHOPAEDICS & SPORTS MEDICINE OF KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-625-3115
Mailing Address - Street 1:789 EASTERN BYP
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2415
Mailing Address - Country:US
Mailing Address - Phone:859-624-4110
Mailing Address - Fax:859-624-0899
Practice Address - Street 1:789 EASTERN BYP
Practice Address - Street 2:SUITE 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2415
Practice Address - Country:US
Practice Address - Phone:859-624-0012
Practice Address - Fax:859-624-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65940025Medicaid
KY000000311396OtherANTHEM PIN
KY7100258740Medicaid
KY7100258750Medicaid
KYDB5273OtherTRAVELLERS MEDICARE
KY7100258740Medicaid
KY7963Medicare PIN