1730220146 NPI number — A. KEITH LETHCO D.M.D.,P.A.

Table of content: (NPI 1730220146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730220146 NPI number — A. KEITH LETHCO D.M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A. KEITH LETHCO D.M.D.,P.A.
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:
Provider Other Organization Name Type Code:
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:
1730220146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1815 MONTAGUE AVENUE EXT
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29649-7501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-223-2433
Provider Business Mailing Address Fax Number:
864-223-3896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 MONTAGUE AVENUE EXT
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29649-7501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-223-2433
Provider Business Practice Location Address Fax Number:
864-223-3896
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LETHCO
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
864-223-2433

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2737 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZ2737 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205918174 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com