Provider Demographics
NPI:1548757859
Name:LEXINGTON VEIN INSTITUTE PLLC
Entity Type:Organization
Organization Name:LEXINGTON VEIN INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-312-9674
Mailing Address - Street 1:3116 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2709
Mailing Address - Country:US
Mailing Address - Phone:859-268-0082
Mailing Address - Fax:
Practice Address - Street 1:3116 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2709
Practice Address - Country:US
Practice Address - Phone:859-312-9674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty