Provider Demographics
NPI:1689607483
Name:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Entity Type:Organization
Organization Name:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Other - Org Name:ST. ANDREWS MEDICINE ASSOCIATES
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 1:7033 ST ANDREWS ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212
Mailing Address - Country:US
Mailing Address - Phone:803-407-3549
Mailing Address - Fax:803-781-7024
Practice Address - Street 1:7033 ST ANDREWS ROAD
Practice Address - Street 2:STE 101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212
Practice Address - Country:US
Practice Address - Phone:803-407-3549
Practice Address - Fax:803-781-7024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2770Medicaid
SCGP2770Medicaid
SCCJ7422Medicare PIN