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  7. NPI Record 1457012205

WELLINGTON PROVIDER GROUP PC
Complete NPI Record 1457012205
Family Medicine in Lexington, KY

NPI Status: Active since January 04, 2022

Contact Information

535 WELLINGTON WAY STE 330
LEXINGTON, KY
ZIP 40503
Phone: (859) 439-0399

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Authorized Official Last Name
  19. Authorized Official First Name
  20. Authorized Official Title or Position
  21. Authorized Official Telephone Number
  22. Healthcare Provider Taxonomy Code 1
  23. Healthcare Provider Primary Taxonomy Switch 1
  24. Healthcare Provider Taxonomy Code 2
  25. Healthcare Provider Primary Taxonomy Switch 2
  26. Healthcare Provider Taxonomy Code 3
  27. Healthcare Provider Primary Taxonomy Switch 3
  28. Healthcare Provider Taxonomy Code 4
  29. Healthcare Provider Primary Taxonomy Switch 4
  30. Healthcare Provider Taxonomy Code 5
  31. Healthcare Provider Primary Taxonomy Switch 5
  32. Healthcare Provider Taxonomy Code 6
  33. Healthcare Provider Primary Taxonomy Switch 6
  34. Healthcare Provider Taxonomy Code 7
  35. Healthcare Provider Primary Taxonomy Switch 7
  36. Is Organization Subpart
  37. Parent Organization LBN
  38. Parent Organization TIN
  39. Healthcare Provider Taxonomy Group 1
  40. Healthcare Provider Taxonomy Group 4
  41. Healthcare Provider Taxonomy Group 5
  42. Healthcare Provider Taxonomy Group 6
  43. Healthcare Provider Taxonomy Group 7
  44. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1457012205. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1457012205
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 535 WELLINGTON WAY STE 330
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Business Mailing Address City Name: LEXINGTON
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: KY
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Postal Code: 405031331
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider First Line Business Practice Location Address: 535 WELLINGTON WAY STE 330
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: LEXINGTON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: KY
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 405031331
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8594390399
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/4/2022
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Last Update Date: 5/18/2023
The date that a record was last updated or changed.
Authorized Official Last Name: DENNIS
The telephone number associated with the location address of the provider being identified.
Authorized Official First Name: BRITTANY
The fax number associated with the location address of the provider being identified.
Authorized Official Title or Position: BILLING/CREDENTIALING MANAGER
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Telephone Number: 8595188817
The date that a record was last updated or changed.
Healthcare Provider Taxonomy Code 1: 208D00000X
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Healthcare Provider Primary Taxonomy Switch 1: N
The first name of the authorized official.
Healthcare Provider Taxonomy Code 2: 261QG0250X
The title or position of the authorized official.
Healthcare Provider Primary Taxonomy Switch 2: N
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 3: 261QP2300X
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 363A00000X
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 363L00000X
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 363LF0000X
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 207Q00000X
Healthcare Provider Primary Taxonomy Switch 7: Y
Is Organization Subpart: Y
Parent Organization LBN: WELLINGTON PROVIDER GROUP PC
Parent Organization TIN: UNAVAIL
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 5/18/2023