Basic Information
| Provider Information | |||||||||
| NPI: | 1326133992 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON ANESTHESIA, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 LEWIS HARGETT CIR | ||||||||
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| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405033590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592681030 | ||||||||
| FaxNumber: | 8592694120 | ||||||||
| Practice Location | |||||||||
| Address1: | 1451 HARRODSBURG ROAD | ||||||||
| Address2: | BUILDING D, SUITE 102 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592762525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | FIELDS | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8592681030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 65913097 | 05 | KY | MEDICAID | 74900127 | 05 | KY | MEDICAID |