Provider Demographics
NPI:1962435750
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:CFO & SR. VP
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 1:146 N HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-791-2985
Mailing Address - Fax:803-936-8042
Practice Address - Street 1:146 N HOSPITAL DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-791-2985
Practice Address - Fax:803-936-8042
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:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1295Medicaid
SCCC2646Medicare PIN
SCGP1295Medicaid