| Benjamin P. Lyon, M.d., Llc | |
|
1138 Lexington Rd Suite 290 Georgetown KY 40324-9672 | |
| (502) 863-0721 | |
| (502) 863-6104 |
| Full Name | Benjamin P. Lyon, M.d., Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1138 Lexington Rd, Georgetown, Kentucky |
| Authorized Official Name and Position | Benjamin P Lyon (OWNER) |
| Authorized Official Contact | 5028630721 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benjamin P. Lyon, M.d., Llc 1138 Lexington Rd Suite 290 Georgetown KY 40324-9672 Ph: (502) 863-0721 | Benjamin P. Lyon, M.d., Llc 1138 Lexington Rd Suite 290 Georgetown KY 40324-9672 Ph: (502) 863-0721 |
| NPI Number | 1518264704 |
|---|---|
| Provider Enumeration Date | 02/24/2011 |
| Last Update Date | 02/24/2011 |
| Medicare PECOS PAC ID | 5991987828 |
|---|---|
| Medicare Enrollment ID | O20110314000341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518264704 | NPI | - | NPPES |
| 64313844 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 313844 (Kentucky) | Primary |
| Provider Name | Benjamin P Lyon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669471645 PECOS PAC ID: 6800078734 Enrollment ID: I20110314000374 |
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