Provider Demographics
NPI:1780341800
Name:LEXINGTON PODIATRY PSC
Entity type:Organization
Organization Name:LEXINGTON PODIATRY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-523-6695
Mailing Address - Street 1:2700 OLD ROSEBUD RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8625
Mailing Address - Country:US
Mailing Address - Phone:859-264-1141
Mailing Address - Fax:859-264-1963
Practice Address - Street 1:2700 OLD ROSEBUD RD STE 250
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8625
Practice Address - Country:US
Practice Address - Phone:859-264-1141
Practice Address - Fax:859-264-1963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON PODIATRY PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-23
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies