Provider Demographics
NPI:1174607741
Name:SOUTH LEXINGTON URGENT TREATMENT ASSOCIATES, PSC
Entity type:Organization
Organization Name:SOUTH LEXINGTON URGENT TREATMENT ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:CHELSIE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-272-4882
Mailing Address - Street 1:3174 CUSTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4000
Mailing Address - Country:US
Mailing Address - Phone:859-272-4882
Mailing Address - Fax:859-273-3916
Practice Address - Street 1:3174 CUSTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4000
Practice Address - Country:US
Practice Address - Phone:859-272-4882
Practice Address - Fax:859-273-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95900510Medicaid
KY65935728Medicaid
KY95900510Medicaid