Healthcare Provider Details

I. General information

NPI: 1063755130
Provider Name (Legal Business Name): BAPTIST PHYSICIANS LEXINGTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 EASTERN BYP SUITE 16
RICHMOND KY
40475-2415
US

IV. Provider business mailing address

4071 TATES CREEK CENTRE DR SUITE 200
LEXINGTON KY
40517-3062
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-6560
  • Fax: 859-624-6569
Mailing address:
  • Phone: 859-624-6560
  • Fax: 859-624-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1177
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number46246
License Number StateKY

VIII. Authorized Official

Name: CATHY SUSAN MOBLEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 859-260-4122