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1333 Taylor St Suite 5-e Columbia SC 29201-2923 | |
(803) 256-1518 | |
(803) 256-9719 |
Full Name | |
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Speciality | Family Medicine |
Location | 1333 Taylor St, Columbia, South Carolina |
Authorized Official Name and Position | Melton R Stuckey (OWNER) |
Authorized Official Contact | 8032542222 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 11098 Columbia SC 29211-1098 Ph: (803) 296-7305 | 1333 Taylor St Suite 5-e Columbia SC 29201-2923 Ph: (803) 256-1518 |
NPI Number | 1336184837 |
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Provider Enumeration Date | 06/18/2006 |
Last Update Date | 01/20/2010 |
Identifier | Type | State | Issuer |
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1336184837 | NPI | - | NPPES |
GP0186 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (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 | |