Basic Information
| Provider Information | |||||||||
| NPI: | 1811953540 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON GYN ONCOLOGY PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1780 NICHOLASVILLE ROAD | ||||||||
| Address2: | 101 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592785671 | ||||||||
| FaxNumber: | 8592785978 | ||||||||
| Practice Location | |||||||||
| Address1: | 1780 NICHOLASVILLE ROAD | ||||||||
| Address2: | 101 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592785671 | ||||||||
| FaxNumber: | 8592785978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DONALDSON | ||||||||
| AuthorizedOfficialFirstName: | ELVIS | ||||||||
| AuthorizedOfficialMiddleName: | SMITH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8592785671 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 16232 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000000050684 | 01 | KY | ANTHEM | OTHER |