| |
2738 Decker Blvd Ste A Columbia SC 29206-1735 | |
(803) 969-0543 | |
(877) 958-9029 |
Full Name | |
---|---|
Speciality | Internal Medicine |
Location | 2738 Decker Blvd Ste A, Columbia, South Carolina |
Authorized Official Name and Position | Angie Martinez (SENIOR CREDENTIALING PROFESSIONAL) |
Authorized Official Contact | 4074477120 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
6101 Blue Lagoon Dr Ste 200 Miami FL 33126-3168 Ph: (305) 500-2000 | 2738 Decker Blvd Ste A Columbia SC 29206-1735 Ph: (803) 969-0543 |
NPI Number | 1356040992 |
---|---|
Provider Enumeration Date | 03/02/2023 |
Last Update Date | 08/19/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356040992 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
208D00000X | General Practice | (* (Not Available)) | Secondary |
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 | |