Provider Demographics
NPI:1457370678
Name:BAPTIST COMMUNITY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:BAPTIST COMMUNITY HEALTH SERVICES, INC
Other - Org Name:BAPTIST PRIME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-575-2101
Mailing Address - Street 1:5158 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9060
Mailing Address - Country:US
Mailing Address - Phone:270-443-4311
Mailing Address - Fax:270-443-4145
Practice Address - Street 1:5158 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9060
Practice Address - Country:US
Practice Address - Phone:270-443-4311
Practice Address - Fax:270-443-4145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST COMMUNITY HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-19
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY700071261QP2300X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3550Medicare PIN
KYCJ4686Medicare PIN
KY3516Medicare PIN