Provider Demographics
NPI:1245495233
Name:BAPTIST CARDIOTHORACIC SURGICAL GROUP
Entity type:Organization
Organization Name:BAPTIST CARDIOTHORACIC SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILL
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:859-260-6100
Mailing Address - Fax:
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 502
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-277-7129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST PHYSICIANS LEXINGTON, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP989208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00574Medicare PIN