Concierge Medical Group Llc | |
110 Wildewood Park Dr Ste A Columbia SC 29223-4301 | |
(803) 722-4988 | |
(803) 656-8135 |
Full Name | Concierge Medical Group Llc |
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Speciality | Clinic/Center |
Location | 110 Wildewood Park Dr Ste A, Columbia, South Carolina |
Authorized Official Name and Position | Sarah Doctor-greenwade (CEO) |
Authorized Official Contact | 8037224988 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Concierge Medical Group Llc Po Box 23328 Columbia SC 29224-3328 Ph: (803) 722-4988 | Concierge Medical Group Llc 110 Wildewood Park Dr Ste A Columbia SC 29223-4301 Ph: (803) 722-4988 |
NPI Number | 1811407521 |
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Provider Enumeration Date | 10/08/2017 |
Last Update Date | 05/30/2024 |
Medicare PECOS PAC ID | 8921367848 |
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Medicare Enrollment ID | O20180122001365 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811407521 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Oliver Pierre Harden |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1164479747 PECOS PAC ID: 7517991789 Enrollment ID: I20050927000368 |
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 | |