| |
2601 Laurel St Suite 120 Columbia SC 29204-2033 | |
(803) 254-7889 | |
(803) 254-7893 |
Full Name | |
---|---|
Speciality | Internal Medicine |
Location | 2601 Laurel St, Columbia, South Carolina |
Authorized Official Name and Position | Angela Haithcock (PROJECT MANAGER) |
Authorized Official Contact | 8038654780 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
114 Gateway Corporate Blvd Suite 425 Columbia SC 29203-9740 Ph: (803) 865-4780 | 2601 Laurel St Suite 120 Columbia SC 29204-2033 Ph: (803) 254-7889 |
NPI Number | 1780998161 |
---|---|
Provider Enumeration Date | 07/28/2010 |
Last Update Date | 02/06/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780998161 | NPI | - | NPPES |
052052 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 5205 (South Carolina) | 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 | |