Full Name | |
---|---|
Speciality | Family Medicine |
Location | 76 Polo Rd, Columbia, South Carolina |
Authorized Official Name and Position | Melinda P Sarvis (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 8037912000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 896239 Charlotte NC 28289-6239 Ph: (803) 699-7255 | 76 Polo Rd Columbia SC 29223 Ph: (803) 699-7255 |
NPI Number | 1346273133 |
---|---|
Provider Enumeration Date | 07/08/2006 |
Last Update Date | 09/17/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346273133 | NPI | - | NPPES |
GP2394 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (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 | |