Healthcare Provider Details

I. General information

NPI: 1972158475
Provider Name (Legal Business Name): BAPTIST HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BEVINS LN
GEORGETOWN KY
40324-6120
US

IV. Provider business mailing address

1901 CAMPUS PL
LOUISVILLE KY
40299-2308
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-0622
  • Fax: 502-868-9097
Mailing address:
  • Phone: 502-253-4911
  • Fax: 502-489-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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