Provider Demographics
NPI:1831299536
Name:CITY OF LEXINGTON
Entity Type:Organization
Organization Name:CITY OF LEXINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:T
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ELLESTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-463-5433
Mailing Address - Street 1:PO BOX 12533
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24026-2533
Mailing Address - Country:US
Mailing Address - Phone:540-981-8612
Mailing Address - Fax:540-344-5674
Practice Address - Street 1:306 SPOTSWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450
Practice Address - Country:US
Practice Address - Phone:540-853-0699
Practice Address - Fax:540-344-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188592OtherANTHEM BCBS