Healthcare Provider Details

I. General information

NPI: 1477898336
Provider Name (Legal Business Name): BAPTIST PHYSICIANS LEXINGTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 THANNOLI DR
SOMERSET KY
42503-2861
US

IV. Provider business mailing address

55 THANNOLI DR
SOMERSET KY
42503-2861
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-0854
  • Fax: 606-677-9311
Mailing address:
  • Phone: 606-677-0854
  • Fax: 606-677-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number31681
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3004692
License Number StateKY

VIII. Authorized Official

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