Healthcare Provider Details

I. General information

NPI: 1720573934
Provider Name (Legal Business Name): BAPTIST HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 FUTURE DR
CORBIN KY
40701-8988
US

IV. Provider business mailing address

1901 CAMPUS PL
LOUISVILLE KY
40299-2308
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-0305
  • Fax: 606-523-4368
Mailing address:
  • Phone: 502-253-4911
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900311
License Number StateKY

VIII. Authorized Official

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