Healthcare Provider Details

I. General information

NPI: 1407411135
Provider Name (Legal Business Name): LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MEDICAL LN STE 300
WEST COLUMBIA SC
29169-4848
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 803-739-3570
  • Fax: 803-739-3575
Mailing address:
  • Phone: 803-739-3570
  • Fax: 803-739-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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