Healthcare Provider Details

I. General information

NPI: 1639211659
Provider Name (Legal Business Name): BAPTIST HEALTH MADISONVILLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 MAIN STREET
CALHOUN KY
42327
US

IV. Provider business mailing address

200 CLINIC DR
MADISONVILLE KY
42431-1661
US

V. Phone/Fax

Practice location:
  • Phone: 270-273-9310
  • Fax:
Mailing address:
  • Phone: 270-825-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CARRICO
Title or Position: CFO
Credential:
Phone: 502-896-5006