| Traditions Health Of Columbia | |
|
7825 Broad River Rd Ste 100 Irmo SC 29063-2375 | |
| (803) 509-8844 | |
| (803) 509-8845 |
| Full Name | Traditions Health Of Columbia |
|---|---|
| Speciality | Clinic/Center |
| Location | 7825 Broad River Rd Ste 100, Irmo, South Carolina |
| Authorized Official Name and Position | John Kerndl (CFO & SECRETARY) |
| Authorized Official Contact | 9797046547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Traditions Health Of Columbia 6840 Carothers Pkwy Ste 550 Franklin TN 37067-8002 Ph: (979) 704-6547 | Traditions Health Of Columbia 7825 Broad River Rd Ste 100 Irmo SC 29063-2375 Ph: (803) 509-8844 |
| NPI Number | 1427794817 |
|---|---|
| Provider Enumeration Date | 05/09/2022 |
| Last Update Date | 06/28/2024 |
| Medicare PECOS PAC ID | 9436444619 |
|---|---|
| Medicare Enrollment ID | O20220629001781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427794817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Steven Barnett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134175557 PECOS PAC ID: 2860395621 Enrollment ID: I20040129000307 |
| Provider Name | Bouvia Mcdaniel-jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033596580 PECOS PAC ID: 4688982358 Enrollment ID: I20150929002343 |
| Provider Name | Clarissa Latoya Carelock-lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184075475 PECOS PAC ID: 7911293154 Enrollment ID: I20160914000881 |
| Provider Name | Mary Legette Fredrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376084970 PECOS PAC ID: 8224384888 Enrollment ID: I20180712000407 |
| Provider Name | Yolanda Boyd-gantt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851953574 PECOS PAC ID: 5395074009 Enrollment ID: I20190905001763 |
| Provider Name | Natasha King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710632633 PECOS PAC ID: 3274918990 Enrollment ID: I20220916001120 |
| Provider Name | Tomeka D Payton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992085401 PECOS PAC ID: 5698036879 Enrollment ID: I20230112000629 |
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