Basic Information
| Provider Information | |||||||||
| NPI: | 1568452290 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST HEALTHCARE SYSTEM, INC. | ||||||||
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| OtherOrganizationName: | BAPTIST HEALTH RICHMOND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 EASTPOINT PKWY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402234166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028965036 | ||||||||
| FaxNumber: | 5028965097 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 EASTERN BYP | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8596233131 | ||||||||
| FaxNumber: | 8596253535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 09/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | OGLESBY | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5028965008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 33601 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Legal Medicine | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 367500000X | 74900705 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 282N00000X | 100322 | KY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 5000007 | 01 | KY | UNITED HEALTHCARE | OTHER | 1083352 | 01 | KY | PASSPORT | OTHER | 6593524900 | 05 | KY | MEDICAID | 01009141 | 05 | KY | MEDICAID | 0060054 | 01 | KY | AETNA PROVIDER # | OTHER | 000000054535 | 01 | KY | ANTHEM BLUE CROSS | OTHER | 000000631053 | 01 | KY | BLUE CROSS - LEARN WELL CLINIC | OTHER | 030165200 | 01 | KY | BLACK LUNG PROVIDER # | OTHER |