Provider Demographics
NPI:1033358726
Name:LEXINGTON PODIATRY PSC
Entity Type:Organization
Organization Name:LEXINGTON PODIATRY PSC
Other - Org Name:LEXINGTON PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FREELS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-264-1141
Mailing Address - Street 1:2700 OLD ROSEBUD RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8625
Mailing Address - Country:US
Mailing Address - Phone:859-264-1141
Mailing Address - Fax:859-264-1963
Practice Address - Street 1:2700 OLD ROSEBUD RD STE 250
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8625
Practice Address - Country:US
Practice Address - Phone:859-264-1141
Practice Address - Fax:859-264-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100146070Medicaid
KY7100108720Medicaid
KY7100438400Medicaid
KY7100438400Medicaid
KY00921Medicare PIN