Healthcare Provider Details

I. General information

NPI: 1144321951
Provider Name (Legal Business Name): NEW LEXINGTON CLINIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

IV. Provider business mailing address

PO BOX 11790
LEXINGTON KY
40578-1790
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-4133
  • Fax: 859-258-4796
Mailing address:
  • Phone: 859-258-6000
  • Fax: 859-258-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KENNETH CRAIK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 859-258-4101