Provider Demographics
NPI:1023426632
Name:MED-LIFE-FIT MEDICAL AND LIFESTYLE MANAGEMENT FAMILY MEDICAL CENTER L
Entity type:Organization
Organization Name:MED-LIFE-FIT MEDICAL AND LIFESTYLE MANAGEMENT FAMILY MEDICAL CENTER L
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-371-9700
Mailing Address - Street 1:10512 MEETING ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7590
Mailing Address - Country:US
Mailing Address - Phone:502-276-4706
Mailing Address - Fax:
Practice Address - Street 1:10512 MEETING ST STE 101
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7590
Practice Address - Country:US
Practice Address - Phone:502-276-4706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-27
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34201207QB0002X, 207Q00000X
363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty