Basic Information
| Provider Information | |||||||||
| NPI: | 1205854163 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON COUNTY HEALTH SERVICE DISTRICT INC. | ||||||||
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| OtherOrganizationName: | LEXINGTON SURGICAL ASSOCIATES-WEST COLUMBIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2720 SUNSET BLVD | ||||||||
| Address2: | ATTN: MANAGED CARE DEPARTMENT | ||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291694810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037912000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2728 SUNSET BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291694838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039392723 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HENDERSON | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDETIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 8039367679 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.