Provider Demographics
NPI:1255426334
Name:LEXINGTON RADIATION THERAPY CENTER, P.S.C.
Entity type:Organization
Organization Name:LEXINGTON RADIATION THERAPY CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAIK
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:859-258-4101
Mailing Address - Street 1:PO BOX 12368
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40583-2368
Mailing Address - Country:US
Mailing Address - Phone:859-258-6705
Mailing Address - Fax:859-258-6509
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE A-100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-258-6505
Practice Address - Fax:859-258-6509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON RADIATION THERAPY CENTER, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCA5414OtherRR MEDICARE NUMBER
KY65912404Medicaid
KYCA5414OtherRR MEDICARE NUMBER
KY8512Medicare ID - Type Unspecified
KY0980Medicare ID - Type Unspecified