Basic Information
| Provider Information | |||||||||
| NPI: | 1710908900 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEXINGTON UROLOGICAL ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 SUMMERPLACE DR | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037969968 | ||||||||
| FaxNumber: | 8037910376 | ||||||||
| Practice Location | |||||||||
| Address1: | 139 SUMMERPLACE DR | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037969968 | ||||||||
| FaxNumber: | 8037910376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 10/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8037969968 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CMM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.