Healthcare Provider Details

I. General information

NPI: 1134492200
Provider Name (Legal Business Name): BAPTIST PHYSICIANS LEXINGTON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NICHOLASVILLE RD SUITE 208
LEXINGTON KY
40503-2518
US

IV. Provider business mailing address

2101 NICHOLASVILLE RD SUITE 208
LEXINGTON KY
40503-2518
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-5454
  • Fax: 859-277-1961
Mailing address:
  • Phone: 859-276-5454
  • Fax: 859-277-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SISSON
Title or Position: PRESIDENT
Credential:
Phone: 859-260-6104