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1200 Colonial Life Blvd W Columbia SC 29210-7670 | |
(803) 213-6775 | |
(803) 678-2138 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 1200 Colonial Life Blvd W, Columbia, South Carolina |
Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
Authorized Official Contact | 2164799063 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5500 Maryland Way Suite 400 Brentwood TN 37027-7048 Ph: () - | 1200 Colonial Life Blvd W Columbia SC 29210-7670 Ph: (803) 213-6775 |
NPI Number | 1598200099 |
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Provider Enumeration Date | 12/20/2016 |
Last Update Date | 08/23/2022 |
Identifier | Type | State | Issuer |
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1598200099 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | 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 | |