Healthcare Provider Details

I. General information

NPI: 1306118617
Provider Name (Legal Business Name): LB HEALTH PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 NICHOLASVILLE RD
LEXINGTON KY
40503-2025
US

IV. Provider business mailing address

1904 NICHOLASVILLE RD
LEXINGTON KY
40503-2025
US

V. Phone/Fax

Practice location:
  • Phone: 859-576-0040
  • Fax:
Mailing address:
  • Phone: 859-576-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY C BURNS
Title or Position: PRESIDENT
Credential: M.D
Phone: 859-576-0040