1992752570 NPI number — LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992752570 NPI number — LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MID CAROLINA INTERNAL MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992752570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 896239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28289-6239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-796-2222
Provider Business Mailing Address Fax Number:
803-796-7839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 SUNSET CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-796-2222
Provider Business Practice Location Address Fax Number:
803-796-7839
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SARVIS
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
803-791-2000

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP4627 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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