MEDICARE: LYNN R SAXON PA

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	363AM0700X	Medical Physician Assistant	PA289	KY
2	363A00000X	Physician Assistant	PA289	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	K095990	OTHER	KY	MEDICARE PTAN - NLSC-RCO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760603708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN R SAXON PA

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-272-5064
Fax Number	:	502-272-5339

Provider Business Practice Location Address
First Line	:	9300 STONESTREET RD
Second Line	:	SUITE 200
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-2863
Country	:	US
Telephone Number	:	502-935-8061
Fax Number	:	502-933-7010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	10/14/2016

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Directions to “ LYNN R SAXON PA” Practice Location

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