Basic Information
| Provider Information | |||||||||
| NPI: | 1750481974 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH LEXINGTON URGENT TREATMENT ASSOCIATES, PSC | ||||||||
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| OtherOrganizationName: | URGENT TREATMENT CLINICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 DOVE RUN RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405023536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592694668 | ||||||||
| FaxNumber: | 8592661152 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 EASTSIDE DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GEORGETOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403249797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028636400 | ||||||||
| FaxNumber: | 5028636559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BACHA | ||||||||
| AuthorizedOfficialFirstName: | FADI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8592694668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 65935736 | 05 | KY | MEDICAID |