Basic Information
| Provider Information | |||||||||
| NPI: | 1821398603 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAPTIST MEDICAL MANAGEMENT SERVICES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAPTIST HEALTH EXPRESS CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424311644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708255100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1756 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424312253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708213300 | ||||||||
| FaxNumber: | 2708212100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2010 | ||||||||
| LastUpdateDate: | 04/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | WHITAKER | ||||||||
| AuthorizedOfficialFirstName: | E | ||||||||
| AuthorizedOfficialMiddleName: | BERTON | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2708255857 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | KY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100149860 | 05 | KY | MEDICAID | 689131 | 01 | KY | ANTHEM GROUP # | OTHER | 7100192750 | 01 | KY | MEDICAID PHYSICIAN GROUP# | OTHER |