MEDICARE: LEXINGTON TWO, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)

General Provider Information

NPI Number	:	1316127541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON TWO, INC

Provider Business Mailing Address
First Line	:	PO BOX 352
Second Line	:	201 CHESTNUT AVENUE
City	:	ALTOONA
State	:	PA
Zip	:	16603-0352
Country	:	US
Telephone Number	:	814-946-5411
Fax Number	:	814-940-8471

Provider Business Practice Location Address
First Line	:	1216 PLEASANT VALLEY BLVD
Second Line	:	SUITE 102
City	:	ALTOONA
State	:	PA
Zip	:	16602-4750
Country	:	US
Telephone Number	:	814-941-1619
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PHILIP L FREEMAN JR.
Credential	:
Telephone Number	:	814-946-5411

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	07/31/2015

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