Healthcare Provider Details

I. General information

NPI: 1003750886
Provider Name (Legal Business Name): SOZO HEALTH KY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 ALEXANDRIA DR
LEXINGTON KY
40504-3160
US

IV. Provider business mailing address

1736 ALEXANDRIA DR
LEXINGTON KY
40504-3160
US

V. Phone/Fax

Practice location:
  • Phone: 859-393-5711
  • Fax:
Mailing address:
  • Phone: 859-393-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BRENT IRELAND
Title or Position: INCORPORATOR
Credential:
Phone: 859-393-5711