=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902237399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAPTIST HEALTH MADISONVILLE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2013
-----------------------------------------------------
Last Update Date | 09/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 MCCOY AVE
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42431-2867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-821-0677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 HOSPITAL DR
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42431-1644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-825-5100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. RICHARD CARRICO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-896-5006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------