Provider Demographics
NPI:1578763660
Name:LEXINGTON COUNTY HEALTH SERV
Entity Type:Organization
Organization Name:LEXINGTON COUNTY HEALTH SERV
Other - Org Name:LEXINGTON MEDICAL CENTER EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-791-2000
Mailing Address - Street 1:PO BOX 896239
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6239
Mailing Address - Country:US
Mailing Address - Phone:803-359-5181
Mailing Address - Fax:803-996-6215
Practice Address - Street 1:815 OLD CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9041
Practice Address - Country:US
Practice Address - Phone:803-796-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON COUNTY HEALTH SERV
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC0236Medicaid
SCDB3445Medicare PIN
SCPC0236Medicaid