Healthcare Provider Details

I. General information

NPI: 1588239669
Provider Name (Legal Business Name): BAPTIST HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NATURE TRL STE 1
RADCLIFF KY
40160-9111
US

IV. Provider business mailing address

5200 COMMERCE CROSSINGS DR FL 3
LOUISVILLE KY
40229-2182
US

V. Phone/Fax

Practice location:
  • Phone: 270-351-0098
  • Fax: 270-352-0860
Mailing address:
  • Phone: 502-253-4911
  • Fax: 502-253-5752

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: EXECUTIVE DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 502-253-4911