Basic Information
Provider Information
NPI: 1215987953
EntityType: 2
ReplacementNPI:  
OrganizationName: PURCHASE ANESTHESIA, PSC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 425 LEWIS HARGETT CIR
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405033590
CountryCode: US
TelephoneNumber: 8592681030
FaxNumber: 8592694120
Practice Location
Address1: 225 MEDICAL CENTER DR
Address2: SUITE 405
City: PADUCAH
State: KY
PostalCode: 420037914
CountryCode: US
TelephoneNumber: 2704414750
FaxNumber: 2704414770
Other Information
ProviderEnumerationDate: 05/11/2006
LastUpdateDate: 01/24/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LYKINS
AuthorizedOfficialFirstName: WALTER
AuthorizedOfficialMiddleName: SCOTT
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8592681030
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
207L00000X  Y193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
710020454005KY MEDICAID
710020457005KY MEDICAID
6594352405KY MEDICAID
7490094505KY MEDICAID
DD880201KYRAILROAD MEDICAREOTHER


Home