Provider Demographics
NPI:1356672927
Name:BLEDSOE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:BLEDSOE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-359-0164
Mailing Address - Street 1:602 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3729
Mailing Address - Country:US
Mailing Address - Phone:803-359-0164
Mailing Address - Fax:803-359-0255
Practice Address - Street 1:669 BARR RD STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2369
Practice Address - Country:US
Practice Address - Phone:803-957-8000
Practice Address - Fax:803-957-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8883207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD99262Medicare UPIN