Healthcare Provider Details

I. General information

NPI: 1700941010
Provider Name (Legal Business Name): BETHANY WOMENS HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N LAKE DR
LEXINGTON SC
29072-2836
US

IV. Provider business mailing address

120 N LAKE DR
LEXINGTON SC
29072-2836
US

V. Phone/Fax

Practice location:
  • Phone: 803-808-1707
  • Fax: 803-356-9327
Mailing address:
  • Phone: 803-808-1707
  • Fax: 803-356-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN30
License Number StateSC

VIII. Authorized Official

Name: MISS LINDA GAIL HANCOCK
Title or Position: OWNER
Credential: CNM, MN
Phone: 803-808-1707