MEDICARE: LEXINGTON PODIATRY PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1780341800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON PODIATRY PSC

Provider Business Mailing Address
First Line	:	2700 OLD ROSEBUD RD STE 250
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8625
Country	:	US
Telephone Number	:	859-264-1141
Fax Number	:	859-264-1963

Provider Business Practice Location Address
First Line	:	2700 OLD ROSEBUD RD STE 250
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8625
Country	:	US
Telephone Number	:	859-264-1141
Fax Number	:	859-264-1963

Authorized Official
Title or Position	:	AUTHORIZED CREDENTIALING AGENT
Name	:	JOY CLEVENGER
Credential	:
Telephone Number	:	502-523-6695

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	07/22/2024

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