Basic Information
| Provider Information | |||||||||
| NPI: | 1932109964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADIX | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ERELIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73 | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422410073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708890282 | ||||||||
| FaxNumber: | 2708878340 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 S VIRGINIA ST | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422403692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708890282 | ||||||||
| FaxNumber: | 2708878340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2005 | ||||||||
| LastUpdateDate: | 11/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 3663 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 32227 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 64047830 | 05 | KY | MEDICAID | 000000220426 | 01 | ANTHEM | OTHER | 390008487 | 01 | RAILROAD MEDICARE | OTHER |