Healthcare Provider Details

I. General information

NPI: 1396724092
Provider Name (Legal Business Name): NORTH LEXINGTON URGENT TREATMENT ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 DOVE RUN RD
LEXINGTON KY
40502-3536
US

IV. Provider business mailing address

1055 DOVE RUN RD SUITE 200
LEXINGTON KY
40502-3536
US

V. Phone/Fax

Practice location:
  • Phone: 859-269-4668
  • Fax: 859-266-5577
Mailing address:
  • Phone: 859-268-0061
  • Fax: 859-266-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FADI BACHA
Title or Position: MEDICAL DIRECTOR PRESIDENT
Credential: MD
Phone: 859-269-4668