1760948863 NPI number — LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.

Table of content: JENNIFER ZEOLLA FRICK MPT (NPI 1710075932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760948863 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:
Provider Other Organization Name Type Code:
6
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:
1760948863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 HULON LANE
Provider Second Line Business Mailing Address:
ATTN: VP - REVENUE CYCLE
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-382-2450
Provider Business Mailing Address Fax Number:
803-382-2469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 SUMMIT CENTRE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-382-2450
Provider Business Practice Location Address Fax Number:
803-382-2469
Provider Enumeration Date:
02/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
AYERS
Authorized Official First Name:
TIFFANY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
803-935-8292

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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