1417082447 NPI number — LEXINGTON ORTHOPAEDICS & SPORTS MEDICINE

Table of content: (NPI 1417082447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417082447 NPI number — LEXINGTON ORTHOPAEDICS & SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEXINGTON ORTHOPAEDICS & SPORTS MEDICINE
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:
LEXINGTON ORTHOPEDIC ASSOCIATES, P.C.
Provider Other Organization Name Type Code:
4
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:
1417082447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 912
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24450-0912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-463-2904
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CROSSING LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24450-3778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-463-2904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEMPHILL
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-463-2103

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101052745 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006402933 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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