Healthcare Provider Details

I. General information

NPI: 1952661894
Provider Name (Legal Business Name): LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 SUNSET BLVD STE 300
WEST COLUMBIA SC
29169
US

IV. Provider business mailing address

470 HULON LANE ATTN: VP - REVENUE CYCLE
WEST COLUMBIA SC
29169
US

V. Phone/Fax

Practice location:
  • Phone: 803-744-4940
  • Fax: 803-744-4938
Mailing address:
  • Phone: 803-744-4940
  • Fax: 803-744-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: TIFFANY AYERS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 803-935-8292