Provider Demographics
NPI:1639199904
Name:LEXINGTON OB GYN ASSOCIATES PSC
Entity Type:Organization
Organization Name:LEXINGTON OB GYN ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:859-278-0396
Mailing Address - Street 1:1700 NICHOLASVILLE RD STE 701
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1467
Mailing Address - Country:US
Mailing Address - Phone:859-278-0396
Mailing Address - Fax:859-277-5414
Practice Address - Street 1:1700 NICHOLASVILLE RD STE 701
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1467
Practice Address - Country:US
Practice Address - Phone:859-278-0396
Practice Address - Fax:859-277-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65904625207V00000X
KY7100514990363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100142080Medicaid
KY60173OtherANTHEM PROVIDER NUMBER
KY7100301180Medicaid
KY7100514990Medicaid
KY60173OtherANTHEM PROVIDER NUMBER
KY7100142080Medicaid
KY7100444030Medicaid