Provider Demographics
NPI:1891065520
Name:MEDCARE EXPRESS-LEXINGTON, LLC
Entity Type:Organization
Organization Name:MEDCARE EXPRESS-LEXINGTON, LLC
Other - Org Name:MEDCARE URGENT CARE, WEST COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-576-5246
Mailing Address - Street 1:1850 SAM RITTENBERG BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4936
Mailing Address - Country:US
Mailing Address - Phone:843-576-5246
Mailing Address - Fax:843-576-5243
Practice Address - Street 1:110 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3642
Practice Address - Country:US
Practice Address - Phone:843-576-5246
Practice Address - Fax:843-576-5243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC267040Medicaid
SC276374Medicaid
SCG56422Medicare UPIN
SC276374Medicaid