Basic Information
| Provider Information | |||||||||
| NPI: | 1699794750 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC. | ||||||||
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| OtherOrganizationName: | LEXINGTON ORTHOPAEDICS LEXINGTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 W MAIN ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039367230 | ||||||||
| FaxNumber: | 8033586208 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 W MAIN ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039367230 | ||||||||
| FaxNumber: | 8033586208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 02/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | KRUZNER | ||||||||
| AuthorizedOfficialFirstName: | MELINDA | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 8037912000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | GP4409 | 05 | SC | MEDICAID |