Healthcare Provider Details

I. General information

NPI: 1982637773
Provider Name (Legal Business Name): LEXINGTON COUNTY HEALTH SERV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/15/2007
Certification Date:
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

2720 SUNSET BLVD ATTN CREDENTIALING
WEST COLUMBIA SC
29169-4810
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-8900
  • Fax:
Mailing address:
  • Phone: 803-936-7679
  • Fax: 803-791-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN HENDERSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 803-936-7679