Basic Information
| Provider Information | |||||||||
| NPI: | 1821021254 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEXINGTON COUNTY HEALTH SERVICES DISTRICT INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LEXINGTON MEDICAL CENTER SWANSEA RHC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 935 WEST 2ND STREET | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035682000 | ||||||||
| FaxNumber: | 8035684190 | ||||||||
| Practice Location | |||||||||
| Address1: | 935 WEST 2ND STREET | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035682000 | ||||||||
| FaxNumber: | 8035684190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 06/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | KRUZNER | ||||||||
| AuthorizedOfficialFirstName: | MELINDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | 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 | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | RHC 507 | 05 | SC | MEDICAID |