NPIMap

Organization Active NPI

Lexington County Health Services District, Inc.

Doing business as Lexington Pediatric Practice

  • Pediatric Adolescent Medicine Physician
  • Lexington, SC
National Provider Identifier
1861418329
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.
Doing business as
Lexington Pediatric Practice
Practice address
811 West Main Street
Ste 204
Lexington, SC 29072
Phone
(803) 359-8855
Fax
(803) 359-1257
NPI assigned
Jul 15, 2006
Last updated
Jun 25, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melinda P Kruzner
Title
Executive Vice President
Phone
(803) 791-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X Primary

Addresses

Primary practice location

811 West Main Street
Ste 204
Lexington, SC 29072

Mailing address

470 Hulon LN
Attn: VP Revenue Cycle
West Columbia, SC 29169
Phone (803) 359-8855

Other practice location 1

3240 Sunset Blvd
West Columbia, SC 29169-3428
Phone (803) 359-8855

Other identifiers 1

IdentifierTypeStateIssuer
GP0991MedicaidSC

Other names 1

  • Lexington Pediatric Practice Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Internal Medicine Assoi17 organizations share this tax ID, including this one
Part of
Internal Medicine Assoi

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

109 Vista Oaks Dr
#C
Lexington, SC 29072
Phone (803) 808-0523

2720 Sunset Blvd
Ste S4400
West Columbia, SC 29169

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1861418329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 HULON LN",
            "address_2": "ATTN: VP REVENUE CYCLE",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "29169",
            "telephone_number": "803-359-8855",
            "fax_number": "803-359-1257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 WEST MAIN STREET",
            "address_2": "STE 204",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "29072",
            "telephone_number": "803-359-8855",
            "fax_number": "803-359-1257"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3240 Sunset Blvd",
            "address_purpose": "LOCATION",
            "city": "West Columbia",
            "state": "SC",
            "postal_code": "291693428",
            "country_code": "US",
            "telephone_number": "803-359-8855",
            "fax_number": "803-794-6480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEXINGTON COUNTY HEALTH SERVICES DISTRICT, INC.",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "KRUZNER",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "803-791-2000"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0991",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lexington Pediatric Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lexington Pediatric Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lexington, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.