MEDICARE: BAPTIST HEALTH RICHMOND, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053656991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST HEALTH RICHMOND, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 34166
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40588-4166
Country	:	US
Telephone Number	:	859-626-0042
Fax Number	:	859-626-0047

Provider Business Practice Location Address
First Line	:	1013 CENTER DRIVE
Second Line	:	#5
City	:	RICHMOND
State	:	KY
Zip	:	40475-2407
Country	:	US
Telephone Number	:	859-626-0042
Fax Number	:	859-626-0047

Authorized Official
Title or Position	:	VP SUPPORT SERVICES
Name	:	PAT OLDS
Credential	:
Telephone Number	:	859-625-3795

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	07/15/2014

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