Healthcare Provider Details

I. General information

NPI: 1730950270
Provider Name (Legal Business Name): BAPTIST HEALTH MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 EASTPOINT PKWY STE 120
LOUISVILLE KY
40223-4154
US

IV. Provider business mailing address

2400 EASTPOINT PKWY STE 120
LOUISVILLE KY
40223-4154
US

V. Phone/Fax

Practice location:
  • Phone: 502-253-6689
  • Fax: 502-253-6680
Mailing address:
  • Phone: 502-253-6689
  • Fax: 502-253-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DANYEL D CLAY
Title or Position: VICE PRESIDENT
Credential:
Phone: 502-253-4911