Provider Demographics
NPI:1417082447
Name:LEXINGTON ORTHOPAEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:LEXINGTON ORTHOPAEDICS & SPORTS MEDICINE
Other - Org Name:LEXINGTON ORTHOPEDIC ASSOCIATES, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEMPHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-463-2103
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-0912
Mailing Address - Country:US
Mailing Address - Phone:540-463-2904
Mailing Address - Fax:
Practice Address - Street 1:25 CROSSING LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3778
Practice Address - Country:US
Practice Address - Phone:540-463-2904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006402933Medicaid
VA200000781Medicare ID - Type Unspecified
VA006402933Medicaid