Provider Demographics
NPI:1326066283
Name:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Entity Type:Organization
Organization Name:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Other - Org Name:DR PD BULLARD JR MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP &CFO
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRUZNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-791-2000
Mailing Address - Street 1:2728 SUNSET BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-936-8080
Mailing Address - Fax:803-936-8079
Practice Address - Street 1:2728 SUNSET BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-936-8080
Practice Address - Fax:803-936-8079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1684Medicaid
SCDP2537OtherRR MEDICARE
SCGP1684Medicaid