Basic Information
| Provider Information | |||||||||
| NPI: | 1922004779 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAPTIST HEALTHCARE SYSTEM, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAPTIST HEALTH HOME CARE BRECKINRIDGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 EASTPOINT PARKWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402234166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028965057 | ||||||||
| FaxNumber: | 2707566401 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 B FAIRGROUNDS ROAD | ||||||||
| Address2: | |||||||||
| City: | HARDINSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401432585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707562662 | ||||||||
| FaxNumber: | 2707566401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | OGLESBY | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5028965008 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAPTIST HEALTHCARE SYSTEM, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 610525158 | KY | N | Agencies | Home Health | 251E00000X | KY150121 | KY | N | Agencies | Home Health | 376J00000X | KY150121 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Related Providers | Homemaker | 251E00000X | KY | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 000000297139 | 01 | KY | ANTHEM BC/BS | OTHER | 42001149 | 05 | KY | MEDICAID | 1050195 | 05 | KY | MEDICAID | 34001149 | 05 | KY | MEDICAID |