Provider Demographics
NPI:1902023195
Name:LEXINGTON FAYETTE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:LEXINGTON FAYETTE COUNTY HEALTH DEPARTMENT
Other - Org Name:MARY TODD ELEMENTARY
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC SERVICES TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:859-252-2371
Mailing Address - Street 1:650 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1113
Mailing Address - Country:US
Mailing Address - Phone:859-252-2371
Mailing Address - Fax:
Practice Address - Street 1:551 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-1726
Practice Address - Country:US
Practice Address - Phone:859-381-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20000477Medicaid