Basic Information
| Provider Information | |||||||||
| NPI: | 1245495233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST CARDIOTHORACIC SURGICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1740 NICHOLASVILLE RD | ||||||||
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| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592606100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1720 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592777129 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2008 | ||||||||
| LastUpdateDate: | 07/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | SISSON | ||||||||
| AuthorizedOfficialFirstName: | BILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8592606100 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAPTIST PHYSICIANS LEXINGTON, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | TP989 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.