Provider Demographics
NPI:1629096581
Name:LEXINGTON COUNTY HEALTH SERV
Entity Type:Organization
Organization Name:LEXINGTON COUNTY HEALTH SERV
Other - Org Name:LEXINGTON FAMILY PRACTICE LAKE MURRAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
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 1:508 HULON LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3439
Mailing Address - Country:US
Mailing Address - Phone:803-785-4747
Mailing Address - Fax:803-785-4750
Practice Address - Street 1:2006 AUGUSTA HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-4810
Practice Address - Country:US
Practice Address - Phone:803-785-4747
Practice Address - Fax:803-785-4750
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:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3226Medicaid
SCCI7041Medicare PIN
SCGP3226Medicaid