Provider Demographics
NPI:1306001649
Name:NEW LEXINGTON CLINIC, PSC
Entity Type:Organization
Organization Name:NEW LEXINGTON CLINIC, PSC
Other - Org Name:LEXINGTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-258-4101
Mailing Address - Street 1:PO BOX 11790
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40578-1790
Mailing Address - Country:US
Mailing Address - Phone:859-258-6000
Mailing Address - Fax:859-258-6123
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-6000
Practice Address - Fax:859-258-6123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LEXINGTON CLINIC, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169OtherMEDICARE GROUP NUMBER
KY95900475Medicaid