1306845813 NPI number — RADIATION ONCOLOGY OF LEXINGTON, PSC

Table of content: (NPI 1306845813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306845813 NPI number — RADIATION ONCOLOGY OF LEXINGTON, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIATION ONCOLOGY OF LEXINGTON, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306845813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 LEWIS HARGETT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-3590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-268-1030
Provider Business Mailing Address Fax Number:
859-269-4120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 NICHOLASVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-226-3858
Provider Business Practice Location Address Fax Number:
502-227-5081
Provider Enumeration Date:
07/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BECKMAN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
SHAREHOLDER
Authorized Official Telephone Number:
859-576-5504

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000051531 . This is a "ANTHEM B/C PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65936577 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: F23735 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".