MEDICARE: BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1710688627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC

Provider Business Mailing Address
First Line	:	1901 CAMPUS PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2308
Country	:	US
Telephone Number	:	502-896-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 BRECKENRIDGE LN STE 500
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1402
Country	:	US
Telephone Number	:	502-928-0050
Fax Number	:	502-928-0059

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. RICHARD CARRICO
Credential	:
Telephone Number	:	502-896-5008

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	05/28/2025

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