Basic Information
Provider Information | |||||||||
NPI: | 1497798847 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BAPTIST HEALTHCARE SYSTEM, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | BAPTIST HEALTH FLOYD | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1850 STATE STREET | ||||||||
Address2: |   | ||||||||
City: | NEW ALBANY | ||||||||
State: | IN | ||||||||
PostalCode: | 471504990 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8129495668 | ||||||||
FaxNumber: | 8129495636 | ||||||||
Practice Location | |||||||||
Address1: | 1850 STATE STREET | ||||||||
Address2: |   | ||||||||
City: | NEW ALBANY | ||||||||
State: | IN | ||||||||
PostalCode: | 471504990 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8129495500 | ||||||||
FaxNumber: | 8129495607 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2006 | ||||||||
LastUpdateDate: | 06/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | OGLESBY | ||||||||
AuthorizedOfficialFirstName: | STEVE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
AuthorizedOfficialTelephone: | 5028965008 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/17/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X |   |   | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 01340058 | 05 | KY |   | MEDICAID | 100270450A | 05 | IN |   | MEDICAID | 108768602 | 05 | TX |   | MEDICAID | 100731 | 01 |   | CHAMPUS | OTHER | 108768601 | 05 | TX |   | MEDICAID |