Healthcare Provider Details

I. General information

NPI: 1972560142
Provider Name (Legal Business Name): HORACE WILLIAM BLEDSOE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2006
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CARRIAGE HILL DR
LEXINGTON SC
29072-7503
US

IV. Provider business mailing address

669 BARR RD
LEXINGTON SC
29072-2369
US

V. Phone/Fax

Practice location:
  • Phone: 803-356-4664
  • Fax: 803-609-3521
Mailing address:
  • Phone: 803-957-8000
  • Fax: 803-957-9025

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:
Title or Position:
Credential:
Phone: