Provider Demographics
NPI:1699787176
Name:JOSEPHINE'S FAYETTE, INC.
Entity type:Organization
Organization Name:JOSEPHINE'S FAYETTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED FITTER-MAS
Authorized Official - Phone:859-269-6222
Mailing Address - Street 1:125 CODELL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1183
Mailing Address - Country:US
Mailing Address - Phone:859-269-6222
Mailing Address - Fax:859-268-7492
Practice Address - Street 1:125 CODELL DR STE 104
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1183
Practice Address - Country:US
Practice Address - Phone:859-269-6222
Practice Address - Fax:859-268-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7525929OtherCIGA
KY7100234150Medicaid
KY7525929OtherCIGA
KY000000321955OtherANTHEM BCBS
KY000000321955OtherFEDERAL BCBS
4984150001Medicare PIN
KY7525929OtherCIGA