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7035 Saint Andrews Rd Columbia SC 29212-1177 | |
(803) 749-0924 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 7035 Saint Andrews Rd, Columbia, South Carolina |
Authorized Official Name and Position | Jeffrey Brillhart (SENIOR VP/CFO) |
Authorized Official Contact | 8037912967 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 6069 West Columbia SC 29171-6069 Ph: () - | 7035 Saint Andrews Rd Columbia SC 29212-1177 Ph: (803) 749-0924 |
NPI Number | 1811594294 |
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Provider Enumeration Date | 10/08/2020 |
Last Update Date | 10/12/2020 |
Medicare PECOS PAC ID | 2567872070 |
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Medicare Enrollment ID | O20201209001892 |
Identifier | Type | State | Issuer |
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1811594294 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
261QR0200X | Clinic/center - Radiology | (* (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 | |