Basic Information
Provider Information | |||||||||
NPI: | 1699793182 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | LEXINGTON MEDICAL CENTER LEXINGTON | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 811 WEST MAIN STREET | ||||||||
Address2: |   | ||||||||
City: | LEXINGTON | ||||||||
State: | SC | ||||||||
PostalCode: | 29072 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8033586100 | ||||||||
FaxNumber: | 8033586167 | ||||||||
Practice Location | |||||||||
Address1: | 811 WEST MAIN STREET | ||||||||
Address2: |   | ||||||||
City: | LEXINGTON | ||||||||
State: | SC | ||||||||
PostalCode: | 29072 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8033586100 | ||||||||
FaxNumber: | 8033586167 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2006 | ||||||||
LastUpdateDate: | 06/01/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KRUZNER | ||||||||
AuthorizedOfficialFirstName: | MELINDA | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | CFO & SR. VP | ||||||||
AuthorizedOfficialTelephone: | 8039394577 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X |   |   | Y |   | Laboratories | Clinical Medical Laboratory |   |
ID Information
ID | Type | State | Issuer | Description | L00135 | 05 | SC |   | MEDICAID |