Provider Demographics
NPI:1699708347
Name:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Entity type:Organization
Organization Name:LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
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 SAINT ANDREWS RD
Mailing Address - Street 2:STE 305
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212
Mailing Address - Country:US
Mailing Address - Phone:803-749-9920
Mailing Address - Fax:803-749-9916
Practice Address - Street 1:7033 SAINT ANDREWS RD
Practice Address - Street 2:STE 305
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212
Practice Address - Country:US
Practice Address - Phone:803-749-9920
Practice Address - Fax:803-749-9916
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:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2035Medicaid
SCGP2035Medicaid
SCCF8291Medicare PIN