| |
112 Norse Dr Columbia SC 29229-3304 | |
(803) 736-0442 | |
Not Available |
Full Name | |
---|---|
Speciality | General Practice |
Location | 112 Norse Dr, Columbia, South Carolina |
Authorized Official Name and Position | William Arthur Shrouds (CFO) |
Authorized Official Contact | 8037360442 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
112 Norse Dr Columbia SC 29229-3304 Ph: (803) 736-0442 | 112 Norse Dr Columbia SC 29229-3304 Ph: (803) 736-0442 |
NPI Number | 1215255617 |
---|---|
Provider Enumeration Date | 05/10/2010 |
Last Update Date | 05/10/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215255617 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | 20616 (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 | |