Healthcare Provider Details

I. General information

NPI: 1588067268
Provider Name (Legal Business Name): BAPTIST HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8727
US

IV. Provider business mailing address

1 TRILLIUM WAY
CORBIN KY
40701-8727
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-8542
  • Fax: 606-528-8661
Mailing address:
  • Phone: 606-523-8542
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANYEL D CLAY
Title or Position: EXECUTIVE DIRECTOR REVENUE CYCLE
Credential:
Phone: 502-253-4911