Lagniappe Medical Clinics, Llc | |
74 Polo Rd Columbia SC 29223-2806 | |
(803) 419-7780 | |
(803) 419-7781 |
Full Name | Lagniappe Medical Clinics, Llc |
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Speciality | Family Medicine |
Location | 74 Polo Rd, Columbia, South Carolina |
Authorized Official Name and Position | Annette Plante (CEO) |
Authorized Official Contact | 8034197780 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Lagniappe Medical Clinics, Llc 74 Polo Rd Columbia SC 29223-2806 Ph: (803) 419-7780 | Lagniappe Medical Clinics, Llc 74 Polo Rd Columbia SC 29223-2806 Ph: (803) 419-7780 |
NPI Number | 1023564622 |
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Provider Enumeration Date | 09/01/2016 |
Last Update Date | 09/18/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023564622 | NPI | - | NPPES |
PENDING | Other | SC | MEDICARE AND MEDICAID PENDING |
GP7652 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 20381 (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 | |