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NPI Code Detail

MEDICARE: NORTH LEXINGTON URGENT TREATMENT ASSOCIATES PSC

MEDICARE: NORTH LEXINGTON URGENT TREATMENT ASSOCIATES PSC
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
1363AM0700XMedical Physician Assistant
2363L00000XNurse Practitioner
3207P00000XEmergency Medicine Physician
4363LF0000XFamily Nurse Practitioner
5207Q00000XFamily Medicine Physician
6207R00000XInternal Medicine Physician

Other Identifiers

General Provider Information

NPI Number : 1396724092
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH LEXINGTON URGENT TREATMENT ASSOCIATES PSC
Provider Business Mailing Address
First Line : 1055 DOVE RUN RD
Second Line : SUITE 200
City : LEXINGTON
State : KY
Zip : 40502-3536
Country : US
Telephone Number : 859-268-0061
Fax Number : 859-266-1152
Provider Business Practice Location Address
First Line : 1055 DOVE RUN RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-3536
Country : US
Telephone Number : 859-269-4668
Fax Number : 859-266-5577
Authorized Official
Title or Position : MEDICAL DIRECTOR PRESIDENT
Name : FADI BACHA
Credential : MD
Telephone Number : 859-269-4668
Provider Enumeration Date : 01/11/2006
Last Update Date : 05/13/2010

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1104873108 — MARTIN JOSEPH MANGAN III MD
Practice Location Address:
1055 DOVE RUN RD , SUITE 200
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1417982299 — DONNA YANCEY FARMER M.D.
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Directions to “NORTH LEXINGTON URGENT TREATMENT ASSOCIATES PSC ” Practice Location

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