| |
811 W Main St Ste 201 Lexington SC 29072 | |
(803) 358-6220 | |
(803) 358-6225 |
Full Name | |
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Speciality | Internal Medicine |
Location | 811 W Main St Ste 201, Lexington, South Carolina |
Authorized Official Name and Position | Melinda P Kruzner (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 8037912000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 896239 Charlotte NC 28289-6239 Ph: (803) 358-6220 | 811 W Main St Ste 201 Lexington SC 29072 Ph: (803) 358-6220 |
NPI Number | 1922026889 |
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Provider Enumeration Date | 07/18/2006 |
Last Update Date | 08/13/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922026889 | NPI | - | NPPES |
GP4196 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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