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General NPI Number Information
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NPI Number | 1326658477
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Entity Type | Organization
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Legal Business Name | PHOENIX ENTERPRISE
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 3191 BEAUMONT CENTRE CIR STE 150
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City | LEXINGTON
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State | KY
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Zip | 40513-1830
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Country | US
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Telephone | 859-900-2668
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W VINE ST STE 1408
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City | LEXINGTON
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State | KY
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Zip | 40507-1814
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Country | US
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Telephone | 859-900-2668
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Fax |
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Authorized Official
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Title or Position | OFFICIAL
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Name | STEVE NETHERTON
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Credential |
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Telephone | 502-551-9988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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