Healthcare Provider Details

I. General information

NPI: 1548757859
Provider Name (Legal Business Name): LEXINGTON VEIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 HARRODSBURG RD
LEXINGTON KY
40503-2709
US

IV. Provider business mailing address

3116 HARRODSBURG RD
LEXINGTON KY
40503-2709
US

V. Phone/Fax

Practice location:
  • Phone: 859-312-9674
  • Fax:
Mailing address:
  • Phone: 859-268-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: FADI BACHA
Title or Position: OWNER
Credential: MD
Phone: 859-312-9674