Provider Demographics
NPI:1154694222
Name:BAPTIST PHYSICIANS LEXINGTON, INC
Entity type:Organization
Organization Name:BAPTIST PHYSICIANS LEXINGTON, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-260-6104
Mailing Address - Street 1:PO BOX 910008
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0008
Mailing Address - Country:US
Mailing Address - Phone:859-260-4385
Mailing Address - Fax:859-260-4386
Practice Address - Street 1:166 PASADENA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2973
Practice Address - Country:US
Practice Address - Phone:859-278-0319
Practice Address - Fax:859-277-9699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST PHYSICIANS LEXINGTON, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100127930Medicaid
KY7100127930Medicaid