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Organization
BAPTIST HEALTH MEDICAL GROUP INC
Active
Organization
BAPTIST HEALTH MEDICAL GROUP INC
Active
Parent organization
BAPTIST HEALTH MEDICAL GROUP INC
Other names
Brannon Crossing Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
BAPTIST HEALTH MEDICAL GROUP INC
Authorized official
MATTHEW LAZARI (VICE PRESIDENT)
(502) 489-8668
Entity
Organization
Contact information
Practice address
100 PROVIDENCE WAY STE 200, NICHOLASVILLE, KY 40356-6033
(859) 260-5370
(859) 260-5379
Mailing address
1901 CAMPUS PL, LOUISVILLE, KY 40299-2308
(502) 253-4911
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18-4931
MEDICARE
—
05
—
7100127930
—
KY
Enumeration date
01/21/2019
Last updated
06/24/2026
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