1508955832 NPI number — LEXINGTON CLINIC CORP

Table of content: (NPI 1508955832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508955832 NPI number — LEXINGTON CLINIC CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEXINGTON CLINIC CORP
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 FAMILY CARE CLINIC
Provider Other Organization Name Type Code:
3
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:
1508955832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38351-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-968-3646
Provider Business Mailing Address Fax Number:
731-968-3646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 W CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38351-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-968-4477
Provider Business Practice Location Address Fax Number:
731-967-1202
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENSON
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
RCD
Authorized Official Telephone Number:
336-944-6420

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0443962 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1513805 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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