Provider Demographics
NPI:1336170158
Name:INTERNAL MEDICINE OF LEXINGTON INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF LEXINGTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:859-277-1166
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE A450
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-277-1166
Mailing Address - Fax:859-277-5336
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE A450
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-277-1166
Practice Address - Fax:859-277-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9217Medicare PIN