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421 Capital Square West Columbia SC 29169-7564 | |
| (803) 791-9422 | |
| (803) 791-9511 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 421 Capital Square, West Columbia, South Carolina |
| Authorized Official Name and Position | Rodney Williams (CFO) |
| Authorized Official Contact | 4073517080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2500 Maitland Center Parkway Suite 250 Maitland FL 32751-4174 Ph: (407) 351-7080 | 421 Capital Square West Columbia SC 29169-7564 Ph: (803) 791-9422 |
| NPI Number | 1902012255 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 09/18/2019 |
| Medicare PECOS PAC ID | 7315372612 |
|---|---|
| Medicare Enrollment ID | O20200114003668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902012255 | NPI | - | NPPES |
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