Healthcare Provider Details

I. General information

NPI: 1831507524
Provider Name (Legal Business Name): SARAH ELIZABETH VICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ELIZABETH WANINGER

II. Dates (important events)

Enumeration Date: 07/26/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0200
US

IV. Provider business mailing address

900 S LIMESTONE ST 304B CHARLES T. WETHINGTON BLDG
LEXINGTON KY
40536-0200
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-9918
  • Fax: 859-323-1197
Mailing address:
  • Phone: 859-323-9918
  • Fax: 859-323-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49993
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number49993
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: