Basic Information
Provider Information
NPI: 1851622948
EntityType: 2
ReplacementNPI:  
OrganizationName: BAPTIST PHYSICIANS LEXINGTON, INC
LastName:  
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OtherOrganizationName: BAPTIST PHYSICIANS RICHMOND
OtherOrganizationType: 3
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Mailing Information
Address1: 4071 TATES CREEK CENTRE DR
Address2: SUITE 202
City: LEXINGTON
State: KY
PostalCode: 405173062
CountryCode: US
TelephoneNumber: 8592604385
FaxNumber: 8592604386
Practice Location
Address1: 107 MERIDIAN WAY
Address2: SUITE 200
City: RICHMOND
State: KY
PostalCode: 404752878
CountryCode: US
TelephoneNumber: 8596246366
FaxNumber: 8596246367
Other Information
ProviderEnumerationDate: 01/29/2010
LastUpdateDate: 12/08/2011
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: SISSON
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT/CEO
AuthorizedOfficialTelephone: 8592606100
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363A00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
207R00000X  Y193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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