MEDICARE: LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1407336076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 896239
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28289-6239
Country	:	US
Telephone Number	:	803-865-2122
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 GATEWAY CORNERS PARK STE 101
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-8906
Country	:	US
Telephone Number	:	803-865-2122
Fax Number	:

Authorized Official
Title or Position	:	SENIOR CREDENTIALING ANALYST
Name	:	CAROLE CHERNY
Credential	:
Telephone Number	:	803-936-7679

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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