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General NPI Number Information
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NPI Number | 1790838423
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Entity Type | Organization
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Legal Business Name | TOTALMED OF LEXINGTON
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1795 ALYSHEBA WAY SUITE 6102
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City | LEXINGTON
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State | KY
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Zip | 40509-2280
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Country | US
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Telephone | 859-263-0374
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Fax |
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Provider Business Mailing Address
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Address Line | 1795 ALYSHEBA WAY SUITE 6102
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City | LEXINGTON
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State | KY
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Zip | 40509-2280
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Country | US
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Telephone | 859-263-0374
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MARK HENDERSON
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Credential | M.D.
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Telephone | 859-263-0374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33009
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License Number State | KY
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