Provider Demographics
NPI:1700803681
Name:NEW LEXINGTON CLINIC, PSC
Entity Type:Organization
Organization Name:NEW LEXINGTON CLINIC, PSC
Other - Org Name:LEXINGTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. DIRECTOR BUS. OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-258-6091
Mailing Address - Street 1:PO BOX 11790
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40578-1790
Mailing Address - Country:US
Mailing Address - Phone:859-258-6000
Mailing Address - Fax:859-258-6123
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-6000
Practice Address - Fax:859-258-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169OtherMEDICARE GROUP NUMBER
KY7684OtherMEDICARE GROUP NUMBER
KY9546OtherMEDICARE GROUP NUMBER
KY6238OtherMEDICARE GROUP NUMBER
KY6267OtherMEDICARE GROUP NUMBER
KY65923740Medicaid
KY7732OtherMEDICARE GROUP NUMBER
KY3567OtherMEDICARE GROUP NUMBER
KY36000818Medicaid
KY6241OtherMEDICARE GROUP NUMBER
KY6263OtherMEDICARE GROUP NUMBER
KY6851OtherMEDICARE GROUP NUMBER
KY9710OtherMEDICARE GROUP NUMBER
KY2253OtherMEDICARE GROUP NUMBER
KY37903705Medicaid
KY6240OtherMEDICARE GROUP NUMBER
KY6244OtherMEDICARE GROUP NUMBER
KY7870OtherMEDICARE GROUP NUMBER
KY8532OtherMEDICARE GROUP NUMBER
KY65923740Medicaid