Healthcare Provider Details

I. General information

NPI: 1407336076
Provider Name (Legal Business Name): LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GATEWAY CORNERS PARK STE 101
COLUMBIA SC
29203-8906
US

IV. Provider business mailing address

PO BOX 896239
CHARLOTTE NC
28289-6239
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-2122
  • Fax:
Mailing address:
  • Phone: 803-865-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLE CHERNY
Title or Position: SENIOR CREDENTIALING ANALYST
Credential:
Phone: 803-936-7679