Provider Demographics
NPI:1790838423
Name:TOTALMED OF LEXINGTON
Entity Type:Organization
Organization Name:TOTALMED OF LEXINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-263-0374
Mailing Address - Street 1:1795 ALYSHEBA WAY
Mailing Address - Street 2:SUITE 6102
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2280
Mailing Address - Country:US
Mailing Address - Phone:859-263-0374
Mailing Address - Fax:
Practice Address - Street 1:1795 ALYSHEBA WAY
Practice Address - Street 2:SUITE 6102
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2280
Practice Address - Country:US
Practice Address - Phone:859-263-0374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty