Organization
LEXINGTON DIABETIC CENTER PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C. ALLEN (CEO)
(859) 977-8855
Entity
Organization
Contact information
Practice address
3292 EAGLE VIEW LN, SUITE 210, LEXINGTON, KY 40509-2173
(859) 977-8855
(859) 977-8856
Mailing address
3292 EAGLE VIEW LN, SUITE 210, LEXINGTON, KY 40509-2173
(859) 977-8855
(859) 977-8856
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
39043
KY
363LF0000X
Family Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000545010
TG ANTHEM LDC
—
01
—
1285781682
TOSHA NPI
KY
05
—
64094485
—
KY
05
—
64313646
—
KY
05
—
65946022
—
KY
01
—
DD2844
TG LDC RR GRP
KY
01
—
P00404838
TG LDC RAILROAD PIN
KY
Enumeration date
01/05/2007
Last updated
01/28/2011
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