| |
6904 N Main St Suite 100 Columbia SC 29203-3852 | |
(803) 735-8307 | |
(803) 735-8668 |
Full Name | |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 6904 N Main St, Columbia, South Carolina |
Authorized Official Name and Position | Delgado Cantave (CEO) |
Authorized Official Contact | 8037335969 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | 6904 N Main St Suite 100 Columbia SC 29203-3852 Ph: (803) 735-8307 |
NPI Number | 1700122967 |
---|---|
Provider Enumeration Date | 12/17/2012 |
Last Update Date | 02/03/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700122967 | NPI | - | NPPES |
4350 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (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 | |