Healthcare Provider Details

I. General information

NPI: 1356672927
Provider Name (Legal Business Name): BLEDSOE FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 BARR RD STE C
LEXINGTON SC
29072-2369
US

IV. Provider business mailing address

602 E MAIN ST SUITE C
LEXINGTON SC
29072-3729
US

V. Phone/Fax

Practice location:
  • Phone: 803-957-8000
  • Fax: 803-957-7004
Mailing address:
  • Phone: 803-359-0164
  • Fax: 803-359-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number8883
License Number StateSC

VIII. Authorized Official

Name: DR. HORACE WILLIAM BLEDSOE JR.
Title or Position: OWNER
Credential: M.D.
Phone: 803-359-0164