Healthcare Provider Details

I. General information

NPI: 1447653142
Provider Name (Legal Business Name): BAPTIST HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIANA CT
PADUCAH KY
42001-6787
US

IV. Provider business mailing address

2605 KENTUCKY AVE SUITE 306
PADUCAH KY
42003-3800
US

V. Phone/Fax

Practice location:
  • Phone: 270-554-0011
  • Fax: 270-554-6525
Mailing address:
  • Phone: 270-415-7653
  • Fax: 270-575-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE P SMITH
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 502-244-6420