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3304 Forest Dr Columbia SC 29204-4024 | |
(803) 787-3901 | |
(803) 787-3902 |
Full Name | |
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Speciality | Clinic/center |
Location | 3304 Forest Dr, Columbia, South Carolina |
Authorized Official Name and Position | Dawn Richardson (VICE PRESIDENT) |
Authorized Official Contact | 8033866374 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 290192 Columbia SC 29229-0004 Ph: (803) 787-3901 | 3304 Forest Dr Columbia SC 29204-4024 Ph: (803) 787-3901 |
NPI Number | 1740626621 |
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Provider Enumeration Date | 05/17/2013 |
Last Update Date | 05/17/2013 |
Identifier | Type | State | Issuer |
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1740626621 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (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 | |