Healthcare Provider Details

I. General information

NPI: 1124937305
Provider Name (Legal Business Name): LX GYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 HARMON RD
BLUFFTON OH
45817-1033
US

IV. Provider business mailing address

547 HARMON RD
BLUFFTON OH
45817-1033
US

V. Phone/Fax

Practice location:
  • Phone: 419-721-4026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DESRENE BROWN
Title or Position: OWNER
Credential:
Phone: 719-721-4026