Healthcare Provider Details
I. General information
NPI: 1043243942
Provider Name (Legal Business Name): ARTHRITIS CENTER OF LEXINGTON
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/07/2006
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
330 WALLER AVE SUITE 100
LEXINGTON KY
40504-2931
US
IV. Provider business mailing address
330 WALLER AVE SUITE 100
LEXINGTON KY
40504-2931
US
V. Phone/Fax
- Phone: 859-254-7000
- Fax: 859-255-4381
- Phone: 859-254-7000
- Fax: 859-255-4381
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RR0500X |
| Taxonomy | Rheumatology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
KELLY
K
COLE
Title or Position: PARTNER
Credential: MD
Phone: 859-254-7000