Provider Demographics
NPI:1982637773
Name:LEXINGTON COUNTY HEALTH SERV
Entity Type:Organization
Organization Name:LEXINGTON COUNTY HEALTH SERV
Other - Org Name:LEXINGTON MEDICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-936-7679
Mailing Address - Street 1:2720 SUNSET BLVD
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4810
Mailing Address - Country:US
Mailing Address - Phone:803-936-7679
Mailing Address - Fax:803-791-2122
Practice Address - Street 1:110 E MEDICAL LN STE 140
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4817
Practice Address - Country:US
Practice Address - Phone:803-936-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXINGTON COUNTY HEALTH SERV
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4221Medicaid
SCDE1744Medicare PIN
SCGP4221Medicaid