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2739 Laurel St Suite 1-a Columbia SC 29204-2028 | |
(803) 799-4800 | |
(803) 256-0397 |
Full Name | |
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Speciality | Internal Medicine - Gastroenterology |
Location | 2739 Laurel St, Columbia, South Carolina |
Authorized Official Name and Position | Darrell C. Coven (DIRECTOR-AMBULATORY SERVICES-FINANC) |
Authorized Official Contact | 8032967301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 402145 Atlanta GA 30384-2145 Ph: (803) 296-7305 | 2739 Laurel St Suite 1-a Columbia SC 29204-2028 Ph: (803) 799-4800 |
NPI Number | 1114299575 |
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Provider Enumeration Date | 02/01/2012 |
Last Update Date | 04/10/2012 |
Identifier | Type | State | Issuer |
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1114299575 | NPI | - | NPPES |
GP5853 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (* (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 | |