Healthcare Provider Details

I. General information

NPI: 1558916890
Provider Name (Legal Business Name): BAPTIST HEALTH MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 EASTERN BYP STE 201
RICHMOND KY
40475-2440
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 859-624-2229
  • Fax: 859-625-9458
Mailing address:
  • Phone: 502-253-4911
  • Fax: 502-489-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANYEL D CLAY
Title or Position: EXECUTIVE DIRECTOR REVENUE CYCLE
Credential:
Phone: 502-253-4911