Provider Demographics
NPI:1881789964
Name:NEW LEXINGTON CLINIC, PSC
Entity type:Organization
Organization Name:NEW LEXINGTON CLINIC, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIK
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:859-258-4101
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:859-258-4068
Practice Address - Street 1:1225 S BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4000
Practice Address - Fax:859-258-4068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LEXINGTON CLINIC, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY36000818Medicaid
KY36000818Medicaid