Provider Demographics
NPI:1326156985
Name:GASTROENTEROLOGY SPECIALISTS OF LEXINGTON
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS OF LEXINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-278-8400
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE C305
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-8400
Mailing Address - Fax:859-276-3700
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE C305
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-8400
Practice Address - Fax:859-276-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6800084OtherUNITED HEALTHCARE
KY1196008OtherCHA
KY7059026OtherAETNA
KY000000222477OtherANTHEM BCBS