Healthcare Provider Details

I. General information

NPI: 1518113810
Provider Name (Legal Business Name): LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MEDICAL LN STE 140
WEST COLUMBIA SC
29169-4817
US

IV. Provider business mailing address

PO BOX 896239
CHARLOTTE NC
28289-6239
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-7460
  • Fax: 803-936-7462
Mailing address:
  • Phone: 803-936-7460
  • Fax: 803-936-7462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MELINDA SARVIS
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 803-791-2000