Provider Demographics
NPI:1699701284
Name:LEXINGTON RADIOLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:LEXINGTON RADIOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:SYLVESTER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-791-2365
Mailing Address - Street 1:PO BOX 602420
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2420
Mailing Address - Country:US
Mailing Address - Phone:317-705-5050
Mailing Address - Fax:317-705-5055
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-791-2365
Practice Address - Fax:803-791-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1140Medicaid
SCPA1140Medicaid