Healthcare Provider Details

I. General information

NPI: 1649536772
Provider Name (Legal Business Name): BAPTIST MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 STANLEY GAULT PKWY SUITE 201
LOUISVILLE KY
40223-4197
US

IV. Provider business mailing address

PO BOX 950292
LOUISVILLE KY
40295-0292
US

V. Phone/Fax

Practice location:
  • Phone: 502-238-2801
  • Fax: 502-238-2835
Mailing address:
  • Phone: 502-238-2801
  • Fax: 502-238-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE SMITH
Title or Position: DIRECTOR
Credential:
Phone: 502-238-2801