Healthcare Provider Details

I. General information

NPI: 1629236930
Provider Name (Legal Business Name): BAPTIST PHYSICIANS LEXINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 NICHOLASVILLE RD SUITE 200
LEXINGTON KY
40503-1400
US

IV. Provider business mailing address

1780 NICHOLASVILLE RD SUITE 101
LEXINGTON KY
40503-1400
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-2671
  • Fax: 859-278-5978
Mailing address:
  • Phone: 859-278-2671
  • Fax: 859-278-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM SISSON
Title or Position: CEO
Credential:
Phone: 859-260-6100