Provider Demographics
NPI:1972560142
Name:BLEDSOE, HORACE WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:HORACE
Middle Name:WILLIAM
Last Name:BLEDSOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 BARR RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2369
Mailing Address - Country:US
Mailing Address - Phone:803-957-8000
Mailing Address - Fax:803-957-9025
Practice Address - Street 1:123 CARRIAGE HILL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7503
Practice Address - Country:US
Practice Address - Phone:803-356-4664
Practice Address - Fax:803-609-3521
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8883207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD99262Medicare UPIN