Healthcare Provider Details

I. General information

NPI: 1760783260
Provider Name (Legal Business Name): LEWISVILLE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 EDGELAND HWY
RICHBURG SC
29729-9478
US

IV. Provider business mailing address

3248 EDGELAND HWY
RICHBURG SC
29729-9478
US

V. Phone/Fax

Practice location:
  • Phone: 803-789-6111
  • Fax: 803-789-6118
Mailing address:
  • Phone: 803-789-6111
  • Fax: 803-789-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12773
License Number StateSC

VIII. Authorized Official

Name: MEHRDAD YOUSEFIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-789-6111