Healthcare Provider Details

I. General information

NPI: 1780341800
Provider Name (Legal Business Name): LEXINGTON PODIATRY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 OLD ROSEBUD RD STE 250
LEXINGTON KY
40509-8625
US

IV. Provider business mailing address

2700 OLD ROSEBUD RD STE 250
LEXINGTON KY
40509-8625
US

V. Phone/Fax

Practice location:
  • Phone: 859-264-1141
  • Fax: 859-264-1963
Mailing address:
  • Phone: 859-264-1141
  • Fax: 859-264-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOY CLEVENGER
Title or Position: AUTHORIZED CREDENTIALING AGENT
Credential:
Phone: 502-523-6695