Kaoru Joan Pridgen, M.d., P.a. | |
11 Gateway Corners Park Columbia SC 29203-8902 | |
(803) 462-2335 | |
(803) 462-0375 |
Full Name | Kaoru Joan Pridgen, M.d., P.a. |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 11 Gateway Corners Park, Columbia, South Carolina |
Authorized Official Name and Position | Kaoru Joan Pridgen (MD) |
Authorized Official Contact | 8034622335 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Kaoru Joan Pridgen, M.d., P.a. 11 Gateway Corners Park Columbia SC 29203-8902 Ph: (803) 462-2335 | Kaoru Joan Pridgen, M.d., P.a. 11 Gateway Corners Park Columbia SC 29203-8902 Ph: (803) 462-2335 |
NPI Number | 1235336082 |
---|---|
Provider Enumeration Date | 06/27/2007 |
Last Update Date | 08/29/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235336082 | NPI | - | NPPES |
258562 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 25856 (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 | |