Healthcare Provider Details

I. General information

NPI: 1194753053
Provider Name (Legal Business Name): LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 WEST MAIN STREET
WEST COLUMBIA SC
29072
US

IV. Provider business mailing address

811 WEST MAIN STREET
WEST COLUMBIA SC
29072
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-6100
  • Fax: 803-358-6167
Mailing address:
  • Phone: 803-358-6100
  • Fax: 803-358-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELINDA P KRUZNER
Title or Position: CFO & SR. VP
Credential:
Phone: 803-791-2000