WADE D REYNOLDS DO LLC NPI 1518217389

NPI Information

NPI: 1518217389
Provider Name: WADE D REYNOLDS DO, LLC
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
Doing Business As: IVY PARK FAMILY MEDICINE
CLIA Number: 42D2043348
Address: 111 IVY PARK LN
SUITE C
LEXINGTON, SC
ZIP 29072
Phone: (803) 785-4555

Map and Directions

Get Directions

NPI Details

WADE D REYNOLDS DO, LLC is a primary care clinic center in Lexington, SC. WADE D REYNOLDS DO, LLC NPI is 1518217389. The provider is registered as an organization entity type.
The provider Is Doing Business As Ivy Park Family Medicine.

The provider's business location address is:

111 IVY PARK LN
SUITE C
LEXINGTON, SC
ZIP 29072-289
Phone: (803) 785-4555
Fax: (803) 785-4556

The provider's authorized official is Wade Reynolds .
The authorized official title is President and has the following contact phone number (803) 785-4555.

The CLIA number assigned to this NPI record is 42D2043348 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/19/2012 and was last updated on 9/19/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	0417	SOUTH CAROLINA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI

Next NPI