Provider Demographics
NPI:1306916028
Name:LEXINGTON CLINIC KIDNEY CENTER
Entity type:Organization
Organization Name:LEXINGTON CLINIC KIDNEY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-258-4101
Mailing Address - Street 1:350 ELAINE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2741
Mailing Address - Country:US
Mailing Address - Phone:859-253-2520
Mailing Address - Fax:859-253-2583
Practice Address - Street 1:350 ELAINE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2741
Practice Address - Country:US
Practice Address - Phone:859-253-2520
Practice Address - Fax:859-253-2583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON CLINIC KIDNEY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300084261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169OtherMEDICARE GROUP NUMBER
KY39090311Medicaid
KY39090311Medicaid