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General NPI Number Information
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NPI Number | 1548757859
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Entity Type | Organization
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Legal Business Name | LEXINGTON VEIN INSTITUTE PLLC
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 3116 HARRODSBURG RD
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City | LEXINGTON
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State | KY
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Zip | 40503-2709
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Country | US
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Telephone | 859-312-9674
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Fax |
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Provider Business Mailing Address
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Address Line | 3116 HARRODSBURG RD
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City | LEXINGTON
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State | KY
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Zip | 40503-2709
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Country | US
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Telephone | 859-268-0082
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FADI BACHA
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Credential | MD
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Telephone | 859-312-9674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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