Provider Demographics
NPI:1942536388
Name:BAPTIST URGENT CARE AT BRANNON CROSSING
Entity Type:Organization
Organization Name:BAPTIST URGENT CARE AT BRANNON CROSSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
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:859-260-6100
Mailing Address - Street 1:1740 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1431
Mailing Address - Country:US
Mailing Address - Phone:859-260-4390
Mailing Address - Fax:859-260-4399
Practice Address - Street 1:610 EAST BRANNON ROAD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:859-260-5540
Practice Address - Fax:859-260-5545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST PHYISICANS LEXINGTON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-20
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00574Medicare PIN