Provider Demographics
NPI:1619017878
Name:LEXINGTON FOOT & ANKLE CENTER PSC
Entity Type:Organization
Organization Name:LEXINGTON FOOT & ANKLE CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-278-8855
Mailing Address - Street 1:202 KIDD DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9593
Mailing Address - Country:US
Mailing Address - Phone:859-278-8855
Mailing Address - Fax:859-278-8856
Practice Address - Street 1:202 KIDD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-9593
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:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00236213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1285781682OtherSTONER NPI
KY1245256270OtherHARROD NPI
KY1821023250OtherOUTSA NPI
KY80900061Medicaid
KY1487681565OtherALLEN NPI
KY1659319721OtherFINE NPI
KYU69572Medicare UPIN
KY1821023250OtherOUTSA NPI
KY1659319721OtherFINE NPI
KY1285781682OtherSTONER NPI
KS6569Medicare ID - Type UnspecifiedMEDICARE GROUP