| |
3010 Farrow Rd Suite 230 Columbia SC 29203-7607 | |
(803) 799-1284 | |
(803) 799-8148 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 3010 Farrow Rd, Columbia, South Carolina |
Authorized Official Name and Position | Helen Bryson (CEO) |
Authorized Official Contact | 8037998407 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1520 Laurel St Columbia SC 29201-2623 Ph: (803) 799-8407 | 3010 Farrow Rd Suite 230 Columbia SC 29203-7607 Ph: (803) 799-1284 |
NPI Number | 1013939529 |
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Provider Enumeration Date | 07/24/2006 |
Last Update Date | 04/29/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013939529 | NPI | - | NPPES |
FQC030 | Medicaid | SC | |
GP4435 | Medicaid | SC | |
CBP006 | Medicaid | SC | |
FQC043 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 20390 (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 | |