Provider Demographics
NPI:1053490748
Name:LEXINGTON SCHOOL DISTRICT FOUR
Entity Type:Organization
Organization Name:LEXINGTON SCHOOL DISTRICT FOUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-568-1000
Mailing Address - Street 1:607 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:SC
Mailing Address - Zip Code:29160-9702
Mailing Address - Country:US
Mailing Address - Phone:803-568-1000
Mailing Address - Fax:803-568-1020
Practice Address - Street 1:607 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:SC
Practice Address - Zip Code:29160-9702
Practice Address - Country:US
Practice Address - Phone:803-568-1000
Practice Address - Fax:803-568-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSD3204Medicaid