Basic Information
| Provider Information | |||||||||
| NPI: | 1093088163 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST PHYSICIANS LEXINGTON, INC | ||||||||
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| OtherOrganizationName: | BAPTIST NEUROLOGY CENTER - LEXINGTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 799 E BRANNON RD | ||||||||
| Address2: | |||||||||
| City: | NICHOLASVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403566038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592604330 | ||||||||
| FaxNumber: | 8592604334 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592604330 | ||||||||
| FaxNumber: | 8592604334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2012 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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| AuthorizedOfficialLastName: | SISSON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8592606104 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAPTIST PHYSICIANS LEXINGTON, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 2084N0400X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 7100073410 | 05 | KY | MEDICAID |