Healthcare Provider Details

I. General information

NPI: 1891062204
Provider Name (Legal Business Name): BAPTIST HEALTH RICHMOND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 EASTERN BYP SUITE 5
RICHMOND KY
40475-2415
US

IV. Provider business mailing address

789 EASTERN BYP SUITE 5
RICHMOND KY
40475-2415
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-0012
  • Fax: 859-624-0899
Mailing address:
  • Phone: 859-624-4110
  • Fax: 859-624-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PAT OLDS
Title or Position: CFO
Credential:
Phone: 859-625-3115