=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033888649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEXINGTON HOSPITAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2021
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 W CHURCH ST STE B
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38351-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-271-5994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 W CHURCH ST STE A
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38351-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RCD
-----------------------------------------------------
Name | LARRY HENSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-944-6420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------