Provider Demographics
| NPI: | 1922401611 |
|---|---|
| Name: | BAPTIST HEALTH MEDICAL GROUP INC |
| Entity Type: | Organization |
| Organization Name: | BAPTIST HEALTH MEDICAL GROUP INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR REV CYCLE |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DANYEL |
| Authorized Official - Middle Name: | D |
| Authorized Official - Last Name: | CLAY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 502-253-4911 |
| Mailing Address - Street 1: | 5200 COMMERCE CROSSINGS DR FL 3 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LOUISVILLE |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 40229-2182 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 502-253-4911 |
| Mailing Address - Fax: | 502-489-5752 |
| Practice Address - Street 1: | 2605 KENTUCKY AVE |
| Practice Address - Street 2: | SUITE 306 |
| Practice Address - City: | PADUCAH |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 42003-3800 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 270-415-7653 |
| Practice Address - Fax: | 270-575-8359 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2014-10-08 |
| Last Update Date: | 2021-02-18 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103T00000X, 1041C0700X, 207Q00000X, 207V00000X, 207Y00000X, 2084N0400X, 208600000X, 213E00000X, 225100000X, 231H00000X, 235Z00000X, 363A00000X, 363L00000X, 367500000X | ||
| KY | 207RC0000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | K187390 | Medicare PIN |
