Provider Demographics
NPI:1558510826
Name:LEXINGTON DIABETIC CENTER, PSC
Entity Type:Organization
Organization Name:LEXINGTON DIABETIC CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:859-278-8855
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:STE C 115
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-8855
Mailing Address - Fax:859-278-8856
Practice Address - Street 1:3292 EAGLE VIEW LN
Practice Address - Street 2:STE 260
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2173
Practice Address - Country:US
Practice Address - Phone:859-278-8855
Practice Address - Fax:859-278-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care