Healthcare Provider Details

I. General information

NPI: 1568771814
Provider Name (Legal Business Name): NEW LEXINGTON CLINIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-4000
  • Fax:
Mailing address:
  • Phone: 859-258-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: RANDALL K LEMAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 859-258-4101