Healthcare Provider Details

I. General information

NPI: 1174759484
Provider Name (Legal Business Name): BAPTIST PHYSICIANS LEXINGTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 ALYSHEBA WAY SUITE 201
LEXINGTON KY
40509-9023
US

IV. Provider business mailing address

1775 ALYSHEBA WAY SUITE 201
LEXINGTON KY
40509-9023
US

V. Phone/Fax

Practice location:
  • Phone: 859-264-0334
  • Fax: 859-264-0720
Mailing address:
  • Phone: 859-264-0334
  • Fax: 859-264-0720

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 Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

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