74 Polo Road, Llc | |
74 Polo Rd Columbia SC 29223-2806 | |
(803) 419-7780 | |
(803) 419-7781 |
Full Name | 74 Polo Road, Llc |
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Speciality | Clinic/center - Multi-specialty |
Location | 74 Polo Rd, Columbia, South Carolina |
Authorized Official Name and Position | Jeff Lehrich (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 4802357788 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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74 Polo Road, Llc 74 Polo Rd Columbia SC 29223-2806 Ph: (803) 419-7780 | 74 Polo Road, Llc 74 Polo Rd Columbia SC 29223-2806 Ph: (803) 419-7780 |
NPI Number | 1093262628 |
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Provider Enumeration Date | 09/01/2016 |
Last Update Date | 09/01/2016 |
Identifier | Type | State | Issuer |
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1093262628 | NPI | - | NPPES |
PENDING | Other | SC | MEDICARE AND MEDICAID PENDING |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | 20381 (South Carolina) | Primary |
Northlake Family Medical Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3000 Ne Medical Park, Ste 101, Columbia, SC 29223 Phone: 803-419-5131 Fax: 803-419-5130 | |
Lagniappe Medical Clinics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74 Polo Rd, Columbia, SC 29223 Phone: 803-419-7780 Fax: 803-419-7781 | |