Provider Demographics
NPI:1508955832
Name:LEXINGTON CLINIC CORP
Entity Type:Organization
Organization Name:LEXINGTON CLINIC CORP
Other - Org Name:LEXINGTON FAMILY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCD
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-944-6420
Mailing Address - Street 1:200 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2038
Mailing Address - Country:US
Mailing Address - Phone:731-968-3646
Mailing Address - Fax:731-968-3646
Practice Address - Street 1:249 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2013
Practice Address - Country:US
Practice Address - Phone:731-968-4477
Practice Address - Fax:731-967-1202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON CLINIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-12
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0443962Medicaid
TN1513805Medicaid
TN0443962Medicaid