Provider Demographics
NPI:1750729133
Name:WESTERN BAPTIST MEDICAL VENTURES INC
Entity type:Organization
Organization Name:WESTERN BAPTIST MEDICAL VENTURES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN INTEGRATION
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-575-8362
Mailing Address - Street 1:PO BOX 7309
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7309
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0834
Practice Address - Street 1:100 KIANA CT
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6787
Practice Address - Country:US
Practice Address - Phone:270-554-0011
Practice Address - Fax:270-554-6540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN BAPTIST MEDICAL VENTURES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-07
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004564363LF0000X
KY17391207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00211Medicare PIN