Provider Demographics
NPI:1922238534
Name:SOUTH LEXINGTON INSTITUTE FOR METABOLIC SURGERY, PLLC
Entity Type:Organization
Organization Name:SOUTH LEXINGTON INSTITUTE FOR METABOLIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-276-5262
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE B-355
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3763
Mailing Address - Country:US
Mailing Address - Phone:859-276-5262
Mailing Address - Fax:859-277-6509
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE B-355
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3763
Practice Address - Country:US
Practice Address - Phone:859-276-5262
Practice Address - Fax:859-277-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1083619886OtherJOHN M. HARRIS, MD NPI
KY1760601025OtherM. ROSS TEKULVE, MD NPI
KY1891791158OtherJASON P. HARRIS, MD NPI