| |
3209 Colonial Dr Columbia SC 29203-6930 | |
(803) 434-6116 | |
(803) 434-8374 |
Full Name | |
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Speciality | Family Medicine |
Location | 3209 Colonial Dr, Columbia, South Carolina |
Authorized Official Name and Position | William D. Anderson (CMO) |
Authorized Official Contact | 8034346116 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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15 Medical Park Suite 300 Columbia SC 29203-6843 Ph: (803) 545-5022 | 3209 Colonial Dr Columbia SC 29203-6930 Ph: (803) 434-6116 |
NPI Number | 1215969696 |
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Provider Enumeration Date | 07/07/2006 |
Last Update Date | 01/23/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215969696 | NPI | - | NPPES |
GP2223 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
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 | |