Basic Information
| Provider Information | |||||||||
| NPI: | 1619575958 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEXINGTON HEALTH INC | ||||||||
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| OtherOrganizationName: | SOUTHEASTERN ORTHOPAEDICS AND SPORTS MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6069 | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291716069 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 146 E HOSPITAL DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291694800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039367966 | ||||||||
| FaxNumber: | 8039367938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2020 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | BRILLHART | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8037912967 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEXINGTON HEALTH INC | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.