Provider Demographics
NPI:1811953540
Name:LEXINGTON GYN ONCOLOGY PSC
Entity type:Organization
Organization Name:LEXINGTON GYN ONCOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:859-278-5671
Mailing Address - Street 1:1780 NICHOLASVILLE ROAD
Mailing Address - Street 2:101
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-278-5671
Mailing Address - Fax:859-278-5978
Practice Address - Street 1:1780 NICHOLASVILLE ROAD
Practice Address - Street 2:101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-5671
Practice Address - Fax:859-278-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16232207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050684OtherANTHEM
KY000000050684OtherANTHEM
KY=========OtherHUMANA
C65731Medicare UPIN