Provider Demographics
NPI:1831117795
Name:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC..
Entity Type:Organization
Organization Name:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC..
Other - Org Name:INTERNAL 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 1:470 HULON LANE
Mailing Address - Street 2:ATTN: VP- REVENUE CYCLE
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:NC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-796-7270
Mailing Address - Fax:803-796-0106
Practice Address - Street 1:146 EAST HOSPITAL DRIVE
Practice Address - Street 2:SUITE 530
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-796-7270
Practice Address - Fax:803-796-0106
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:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0953Medicaid
SCPA0953Medicaid
SC1511Medicare PIN