Organization
WESTERN BAPTIST MEDICAL VENTURES, INC.
Active
Parent organization
WESTERN BAPTIST MEDICAL VENTURES, INC.
Other names
Paducah Neurosurgical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN BAPTIST MEDICAL VENTURES, INC.
Authorized official
LARRY BARTON (VICE PRESIDENT)
(270) 575-2139
Entity
Organization
Contact information
Practice address
2603 KENTUCKY AVE STE 404, PADUCAH, KY 42003-3830
(270) 443-6472
(270) 442-1649
Mailing address
PO BOX 7909, PADUCAH, KY 42002-7909
(270) 575-2139
(270) 575-2634
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
4059P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000521597
ANTHEM BCBS
KY
05
—
65945867
—
KY
05
—
7100002230
—
KY
01
—
DF7549
RAILROAD MEDICARE
KY
Enumeration date
11/09/2006
Last updated
01/19/2010
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