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General NPI Number Information
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NPI Number | 1558811323
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Entity Type | Organization
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Legal Business Name | KENTUCKY MEDICAL CENTER, PSC
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 208 LEGENDS LN SUITE 130
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City | LEXINGTON
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State | KY
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Zip | 40505-3285
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Country | US
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Telephone | 859-400-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 208 LEGENDS LN SUITE 130
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City | LEXINGTON
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State | KY
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Zip | 40505-3285
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Country | US
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Telephone | 859-400-0123
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BLAINE LISNER
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Credential | M.D.
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Telephone | 859-400-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 25368
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License Number State | KY
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