Provider Demographics
NPI:1891836235
Name:BAPTIST HEALTH DEACONESS MADISONVILLE INC
Entity Type:Organization
Organization Name:BAPTIST HEALTH DEACONESS MADISONVILLE INC
Other - Org Name:BAPTIST HEALTH DEACONESS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-896-5006
Mailing Address - Street 1:900 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1644
Mailing Address - Country:US
Mailing Address - Phone:270-836-4660
Mailing Address - Fax:270-326-4669
Practice Address - Street 1:200 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-326-4660
Practice Address - Fax:270-326-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY44001758Medicaid
KY000000054633OtherANTHEM PROVIDER NUMBER
KY44001758Medicaid