1306001649 NPI number — NEW LEXINGTON CLINIC, PSC

Table of content: (NPI 1306001649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306001649 NPI number — NEW LEXINGTON CLINIC, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LEXINGTON CLINIC, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEXINGTON CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306001649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40578-1790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-258-6000
Provider Business Mailing Address Fax Number:
859-258-6123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-258-6000
Provider Business Practice Location Address Fax Number:
859-258-6123
Provider Enumeration Date:
07/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEMAY
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
859-258-4101

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0169 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 95900475 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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